Healthcare Provider Details

I. General information

NPI: 1780668806
Provider Name (Legal Business Name): MONICA LYNN SCHUTT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONICA L. FOURNIER

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9419 COPPERTOP LOOP NE
BAINBRIDGE ISLAND WA
98110-3647
US

IV. Provider business mailing address

9419 COPPERTOP LOOP NE
BAINBRIDGE ISLAND WA
98110-3647
US

V. Phone/Fax

Practice location:
  • Phone: 206-842-2428
  • Fax: 206-842-2890
Mailing address:
  • Phone: 206-842-2428
  • Fax: 206-842-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29402
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3303
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: