Provider Demographics
NPI:1790985604
Name:MINOR, MISTY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:A
Last Name:MINOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:A
Other - Last Name:THOMASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5708 COMANCHE PEAK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7103
Mailing Address - Country:US
Mailing Address - Phone:817-733-5009
Mailing Address - Fax:
Practice Address - Street 1:2800 E HIGHWAY 114 STE 120
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5305
Practice Address - Country:US
Practice Address - Phone:817-491-3403
Practice Address - Fax:817-491-3308
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist