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General NPI Number Information
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NPI Number | 1114222924
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Entity Type | Organization
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Legal Business Name | MONICA A PREROVSKY
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 4671 SAN YSIDRO PLACE
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City | SANTA FE
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State | NM
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Zip | 87507
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Country | US
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Telephone | 505-577-3326
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Fax | 505-988-7187
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Provider Business Mailing Address
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Address Line | 4671 SAN YSIDRO PLACE
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City | SANTA FE
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State | NM
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Zip | 87507
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Country | US
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Telephone | 505-577-3326
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Fax | 505-988-7187
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MONICA ANN PREROVSKY
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Credential | MPT
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Telephone | 505-577-3326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2683
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License Number State | NM
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