Provider Demographics
NPI:1679581151
Name:MINER, CATHY MONIQUE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:MONIQUE
Last Name:MINER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:MONIQUE
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:907 ERIE DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-2592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:164 W HART ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1738
Practice Address - Country:US
Practice Address - Phone:307-684-8623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist