Provider Demographics
NPI:1073728416
Name:MINER, MARTINE (LMT, NCTMB)
Entity type:Individual
Prefix:MS
First Name:MARTINE
Middle Name:
Last Name:MINER
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KENNEY LN
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-4147
Mailing Address - Country:US
Mailing Address - Phone:508-643-0480
Mailing Address - Fax:508-384-7336
Practice Address - Street 1:844 FRANKLIN ST
Practice Address - Street 2:UNIT 9
Practice Address - City:WRENTHAM
Practice Address - State:MA
Practice Address - Zip Code:02093-1223
Practice Address - Country:US
Practice Address - Phone:508-384-3436
Practice Address - Fax:508-384-7336
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA426016-00172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist