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Individual

NICOLE MONAHAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
3691 WILLOWCREEK RD STE 100, PORTAGE, IN 46368-5000
(219) 759-4380
(219) 759-1989
Mailing address
3691 WILLOWCREEK RD STE 100, PORTAGE, IN 46368-5000
(219) 759-4380
(219) 759-1989

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
06006164A
PTA
IN
Enumeration date
12/15/2020
Last updated
12/15/2020
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