Provider Demographics
NPI:1962392571
Name:MONU, FAFA S (PTA)
Entity type:Individual
Prefix:
First Name:FAFA
Middle Name:S
Last Name:MONU
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 1:7801 OLD BRANCH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1641
Mailing Address - Country:US
Mailing Address - Phone:301-856-8386
Mailing Address - Fax:
Practice Address - Street 1:7801 OLD BRANCH AVE STE 105
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1641
Practice Address - Country:US
Practice Address - Phone:301-856-8386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4328225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant