MEDICARE: MS. BAMBI RENAE MONROE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	001347	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689624314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BAMBI RENAE MONROE PT

Provider Business Mailing Address
First Line	:	1500 GRAND CENTRAL AVE STE 101
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-1079
Country	:	US
Telephone Number	:	304-693-2781
Fax Number	:	304-693-2171

Provider Business Practice Location Address
First Line	:	2434 RICHMILLER LN UNIT B
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-1075
Country	:	US
Telephone Number	:	740-423-1500
Fax Number	:	740-423-1504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	09/19/2023

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