Provider Demographics
NPI:1588709224
Name:MONACH, KATHLEEN MARIE (MPT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MONACH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:ZWEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1343 VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-232-2878
Mailing Address - Fax:816-232-5056
Practice Address - Street 1:1343 VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-232-2878
Practice Address - Fax:816-232-5056
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11 02273225100000X
MO108114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO28076013OtherBCBS