Provider Demographics
NPI:1407962582
Name:MINER, MICHAEL C (MPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:C
Last Name:MINER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 GUM BRANCH RD STE 600
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4008
Mailing Address - Country:US
Mailing Address - Phone:910-353-9800
Mailing Address - Fax:910-455-2083
Practice Address - Street 1:2453 GUM BRANCH ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:910-353-9800
Practice Address - Fax:910-455-2083
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1182225100000X
NC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD41743Medicare UPIN