Provider Demographics
NPI:1699100107
Name:MONAGHAN, AMBER JUNE (PTA)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:JUNE
Last Name:MONAGHAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:JUNE
Other - Last Name:REDDOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1901 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2546
Mailing Address - Country:US
Mailing Address - Phone:817-877-8977
Mailing Address - Fax:817-877-1106
Practice Address - Street 1:1901 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2546
Practice Address - Country:US
Practice Address - Phone:817-877-8977
Practice Address - Fax:817-877-1106
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20973227225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant