Provider Demographics
NPI:1073555843
Name:MINNER, DEANNA JEAN (MSPT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:JEAN
Last Name:MINNER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:JEAN
Other - Last Name:ZIRCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:12900 E LOOP 1604 N
Mailing Address - Street 2:APT 713
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3169
Mailing Address - Country:US
Mailing Address - Phone:210-566-8569
Mailing Address - Fax:
Practice Address - Street 1:12412 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3255
Practice Address - Country:US
Practice Address - Phone:210-646-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1167070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist