Provider Demographics
NPI:1619194164
Name:MONILLA, HENRY M (PT)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:M
Last Name:MONILLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BROOKFIELD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4037
Mailing Address - Country:US
Mailing Address - Phone:508-405-1430
Mailing Address - Fax:
Practice Address - Street 1:70 BROOKFIELD CIRCLE
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4037
Practice Address - Country:US
Practice Address - Phone:508-405-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6646314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility