Individual
JACQUELINE DORIS MONCKTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5037 N EDGEBROOK DR, PEORIA, IL 61614-4826
(309) 657-3303
Mailing address
5037 N EDGEBROOK DR, PEORIA, IL 61614-4826
(309) 657-3303
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160000586
IL
Other
Enumeration date
09/25/2018
Last updated
09/25/2018
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