Provider Demographics
NPI:1023137031
Name:MATTOCKS, MONICA CHRISTINA (PTA)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:CHRISTINA
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:VT
Mailing Address - Zip Code:05354-0112
Mailing Address - Country:US
Mailing Address - Phone:802-254-2518
Mailing Address - Fax:
Practice Address - Street 1:80 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6551
Practice Address - Country:US
Practice Address - Phone:802-254-4977
Practice Address - Fax:802-254-8842
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003319225100000X
NH2399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist