Provider Demographics
NPI:1154415792
Name:MONK, JAMES GREGORY (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GREGORY
Last Name:MONK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 REGAL RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-9499
Mailing Address - Country:US
Mailing Address - Phone:502-552-5045
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIRCLE
Practice Address - Street 2:SUITE L14
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-899-1911
Practice Address - Fax:502-899-1981
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003934225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00280004OtherRAILROAD MEDICARE
KYP00280004OtherRAILROAD MEDICARE
5027501Medicare PIN