Provider Demographics
NPI:1932103447
Name:MINTER, BRETT A (PT)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:A
Last Name:MINTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 PROGRESS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-8800
Mailing Address - Country:US
Mailing Address - Phone:706-698-3000
Mailing Address - Fax:
Practice Address - Street 1:943 PROGRESS RD STE 2
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8800
Practice Address - Country:US
Practice Address - Phone:706-698-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6999225100000X
GA5239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3659205Medicaid
GA380348284AMedicaid
TN4092611OtherBCBS
GA10035561OtherAMERIGROUP
GA65BBCLSMedicare ID - Type Unspecified