Provider Demographics
NPI:1255516753
Name:MONNAHAN, PAMELA L (PT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:MONNAHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:ZEMNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 CORPORATE DR
Mailing Address - Street 2:STE 190
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1152
Mailing Address - Country:US
Mailing Address - Phone:949-218-0790
Mailing Address - Fax:949-218-0791
Practice Address - Street 1:800 CORPORATE DR
Practice Address - Street 2:STE 190
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-1152
Practice Address - Country:US
Practice Address - Phone:949-218-0790
Practice Address - Fax:949-218-0791
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT169922251G0304X, 2251S0007X, 225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT169920Medicare PIN