Doctor Name: | MR. JEREMY ARTHUR MINNICK |
NPI Number: | 1659471522 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT |
License Number: | MA 25921 |
Business Practice Address: | 2143 Nw 17th Ave Cape Coral, FL - 339933101 |
Business Phone Number: | 2396719900 |
Business Fax Number: | 2397720146 |
Mailing Address: | 2143 Nw 17th Ave, CAPE CORAL |
State: | FL |
Postal Code: | 339933101 |
Phone Number: | 2396719900 |
Fax Number: | 2397720146 |
NPI Enumeration Date: | 09/22/2006 |
NPI Last Update Date: | 07/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA 25921 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |