Healthcare Provider Details

I. General information

NPI: 1073816948
Provider Name (Legal Business Name): STEPHEN ANTHONY MONISIT P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9395 CHARTRIDGE CV
CORDOVA TN
38016-2386
US

IV. Provider business mailing address

9395 CHARTRIDGE CV
CORDOVA TN
38016-2386
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-5967
  • Fax:
Mailing address:
  • Phone: 901-757-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4075
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: