Provider Demographics
NPI:1164810552
Name:MINTON, JEAN (PT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:MINTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 S FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-4631
Mailing Address - Country:US
Mailing Address - Phone:336-584-1722
Mailing Address - Fax:
Practice Address - Street 1:3018 S FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-4631
Practice Address - Country:US
Practice Address - Phone:336-584-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP1189174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist