Basic Information
| Provider Information | |||||||||
| NPI: | 1386690600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINA | ||||||||
| FirstName: | CHARITO | ||||||||
| MiddleName: | APOLONIO | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CORPORATE DR | ||||||||
| Address2: | STE 400 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352425424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232388923 | ||||||||
| FaxNumber: | 4239547399 | ||||||||
| Practice Location | |||||||||
| Address1: | 3007 NE WEST DEVILS LAKE RD | ||||||||
| Address2: | |||||||||
| City: | LINCOLN CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973675131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419946252 | ||||||||
| FaxNumber: | 5419946355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 07/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0687 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.