Provider Demographics
NPI:1750695771
Name:MINICONE, CHRISTOPHER LAWRENCE (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LAWRENCE
Last Name:MINICONE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8835 WHEAT CROSS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5214
Mailing Address - Country:US
Mailing Address - Phone:281-855-1050
Mailing Address - Fax:281-855-1070
Practice Address - Street 1:8835 WHEAT CROSS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-5214
Practice Address - Country:US
Practice Address - Phone:281-855-1050
Practice Address - Fax:281-855-1070
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist