Jacqueline Doris Monckton

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160000586 Issued in IL

Practice address

5037 N Edgebrook Dr
Peoria, IL 61614-4826

Phone

(309) 657-3303

NPI assigned

Sep 25, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537833600000",
    "number": "1871078899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5037 N EDGEBROOK DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144826",
            "telephone_number": "309-657-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5037 N EDGEBROOK DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144826",
            "telephone_number": "309-657-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONCKTON",
        "first_name": "JACQUELINE",
        "middle_name": "DORIS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-25",
        "last_updated": "2018-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160000586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maryam Moin, M.D.
• Sherry Lee Molburg, MSW
• Michael Momchev, DDS
• Moments Hospice of Peoria LLC
• Lisa Monagle, RDN
• Shannon Leigh Monckton, PTA
• Jamie Monier, SLP
• Sharon Morrissy Monier, LCSW
• Cheryl Jones Monroe, PT
• Edward Monroe, R. PH.

• Physical Therapy Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.