Basic Information
| Provider Information | |||||||||
| NPI: | 1750321121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | CLARE | ||||||||
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| Credential: | BSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9315 GRAVELLY LAKE DR SW | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984991574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535815200 | ||||||||
| FaxNumber: | 2535815203 | ||||||||
| Practice Location | |||||||||
| Address1: | 7727 40TH ST W | ||||||||
| Address2: | SUITE A | ||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984663146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534601362 | ||||||||
| FaxNumber: | 2534606628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00006294 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8441842 | 05 | WA | MEDICAID | 4677MU | 01 | WA | BLUE SHIELD # VM | OTHER | 0206081 | 01 | WA | LABOR & INDUSTRIES | OTHER | 7715MU | 01 | WA | REGENCE BLUESHIELD | OTHER | 8940832 | 01 | WA | L&I CRIME VICTIMS PRGM | OTHER |