Provider Demographics
NPI:1083647614
Name:MINER, TODD EDWARD (PT)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:EDWARD
Last Name:MINER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:71847 HIGHWAY 111
Mailing Address - Street 2:SUITE C
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-6406
Mailing Address - Country:US
Mailing Address - Phone:760-776-1911
Mailing Address - Fax:760-776-4833
Practice Address - Street 1:71847 HIGHWAY 111
Practice Address - Street 2:SUITE C
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-6406
Practice Address - Country:US
Practice Address - Phone:760-776-1911
Practice Address - Fax:760-776-4833
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT207340Medicare PIN