Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT16943 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT16943 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT16943 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT16943 | CA |
NPI | 1447435946 |
---|---|
Provider Name | Michael S Monnahan |
First Address | Ladera Ranch, CA 92694-1152 |
Second Address | Ladera Ranch, CA 92694-1152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 04/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0PT169430 | BLUE SHIELD (01) | CA |