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General NPI Number Information
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NPI Number | 1396326997
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Entity Type | Individual
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Provider Name | CHRISTOPHER NICHOLAS MONGNO
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Gender | Male
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 50 PLAZA DR STE 104
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City | PALM COAST
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State | FL
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Zip | 32137-8549
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Country | US
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Telephone | 386-447-5447
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Fax | 386-447-5502
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Provider Business Mailing Address
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Address Line | 234 EDGE PARK TRL
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-1921
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Country | US
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Telephone | 631-672-7493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA30893
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License Number State | FL
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