Provider Demographics
NPI:1033346572
Name:MONZO, KRISTEN HEATHER (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:HEATHER
Last Name:MONZO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:HEATHER
Other - Last Name:VERES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 KENMOOR AVE SE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2395
Mailing Address - Country:US
Mailing Address - Phone:616-356-5000
Mailing Address - Fax:616-356-5001
Practice Address - Street 1:501 FOREST LN STE A
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2621
Practice Address - Country:US
Practice Address - Phone:864-654-2001
Practice Address - Fax:800-305-7112
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13829225100000X
SC6931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist