Basic Information
| Provider Information | |||||||||
| NPI: | 1871727800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAUTHEN | ||||||||
| FirstName: | MINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11403 CEDAR GULLY RD | ||||||||
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| City: | BEACH CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775238280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814138015 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4225 LAKE ARTHUR DR | ||||||||
| Address2: | |||||||||
| City: | PORT ARTHUR | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776426490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097220714 | ||||||||
| FaxNumber: | 4097220714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 05/05/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2058681 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.