Provider Demographics
NPI:1427447515
Name:WATSON, MONIQUE DELUCA (PT, DPT, OCS)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:DELUCA
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:DR
Other - First Name:MONIQUE
Other - Middle Name:GABRIELLE
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, OCS
Mailing Address - Street 1:10700 CHARTER DR STE 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3687
Mailing Address - Country:US
Mailing Address - Phone:443-546-1590
Mailing Address - Fax:
Practice Address - Street 1:10700 CHARTER DR STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3687
Practice Address - Country:US
Practice Address - Phone:443-546-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038329225100000X
MD27463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist