Provider Demographics
NPI:1063461077
Name:MINSKE, CARRIE E (MPT)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:E
Last Name:MINSKE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2407
Mailing Address - Country:US
Mailing Address - Phone:760-591-7750
Mailing Address - Fax:760-410-0140
Practice Address - Street 1:1595 GRAND AVE
Practice Address - Street 2:STE. 106
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2450
Practice Address - Country:US
Practice Address - Phone:760-417-2440
Practice Address - Fax:760-471-2442
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25480CMedicare ID - Type Unspecified
CAWPT25480AMedicare ID - Type Unspecified
CAWPT25480BMedicare ID - Type Unspecified