Provider Demographics
NPI:1851098420
Name:MASSOUD, MONICA (DPT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MASSOUD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MIKHAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 196TH PL SW
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7078
Mailing Address - Country:US
Mailing Address - Phone:425-599-7940
Mailing Address - Fax:
Practice Address - Street 1:22118 20TH AVE SE STE 139
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4424
Practice Address - Country:US
Practice Address - Phone:425-485-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61150347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2237681Medicaid