Provider Demographics
NPI:1326207408
Name:MINOIA, THERESA M (CHT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:MINOIA
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-0393
Mailing Address - Country:US
Mailing Address - Phone:509-468-7868
Mailing Address - Fax:509-468-7868
Practice Address - Street 1:705 W BELLWOOD DR APT 67
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3316
Practice Address - Country:US
Practice Address - Phone:509-468-7868
Practice Address - Fax:509-468-7868
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHP10001688174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist