Provider Demographics
NPI:1629459128
Name:MINER, ALLISON PATRICE (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:PATRICE
Last Name:MINER
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 MURPHY CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4407
Mailing Address - Country:US
Mailing Address - Phone:858-874-4500
Mailing Address - Fax:
Practice Address - Street 1:4020 MURPHY CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4407
Practice Address - Country:US
Practice Address - Phone:858-874-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298612251S0007X
CA0201020142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer