MEDICARE: MRS. KATHLEEN M MONZYK PT

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	2251X0800X	Orthopedic Physical Therapist	117828	MO

General Provider Information

NPI Number	:	1093745507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN M MONZYK PT

Provider Business Mailing Address
First Line	:	12539 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6311
Country	:	US
Telephone Number	:	314-205-2006
Fax Number	:	142-052-2413

Provider Business Practice Location Address
First Line	:	12539 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6311
Country	:	US
Telephone Number	:	314-205-2006
Fax Number	:	142-052-2413

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	04/26/2024

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