MEDICARE: MONICA PREROVSKY MPT

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	2683	NM

General Provider Information

NPI Number	:	1811010556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA PREROVSKY MPT

Provider Business Mailing Address
First Line	:	PO BOX 10141
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87504-6141
Country	:	US
Telephone Number	:	505-577-3326
Fax Number	:	505-988-7187

Provider Business Practice Location Address
First Line	:	4671 SAN YSIDRO PL
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-3485
Country	:	US
Telephone Number	:	505-577-3326
Fax Number	:

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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Directions to “ MONICA PREROVSKY MPT” Practice Location

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