Provider Demographics
NPI:1720100555
Name:MINCE, JULIE (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MINCE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77067-1956
Mailing Address - Country:US
Mailing Address - Phone:281-397-4024
Mailing Address - Fax:281-397-4003
Practice Address - Street 1:11920 WALTERS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-1956
Practice Address - Country:US
Practice Address - Phone:281-397-4024
Practice Address - Fax:281-397-4003
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2007746225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant