Provider Demographics
NPI:1508929761
Name:NOLTEE, MINERVA (LMT CNMT CTMP)
Entity Type:Individual
Prefix:MRS
First Name:MINERVA
Middle Name:
Last Name:NOLTEE
Suffix:
Gender:F
Credentials:LMT CNMT CTMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 CRESTVIEW CIR NW
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-2118
Mailing Address - Country:US
Mailing Address - Phone:941-255-8526
Mailing Address - Fax:941-764-8609
Practice Address - Street 1:796 CRESTVIEW CIR NW
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-2118
Practice Address - Country:US
Practice Address - Phone:941-255-8526
Practice Address - Fax:941-764-8609
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA39051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist