Provider Demographics
NPI:1518011428
Name:MINZENBERGER, KATHY MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MARIE
Last Name:MINZENBERGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 ANDROS AVE
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3311
Mailing Address - Country:US
Mailing Address - Phone:321-868-7190
Mailing Address - Fax:
Practice Address - Street 1:49 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2713
Practice Address - Country:US
Practice Address - Phone:321-783-5592
Practice Address - Fax:321-783-0558
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA16359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA16359OtherFL MASSAGE NUMBER