Provider Demographics
NPI:1285387001
Name:MINER, HAVEN (PTA)
Entity type:Individual
Prefix:
First Name:HAVEN
Middle Name:
Last Name:MINER
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 1:271 SNELLINGS LN
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:MO
Mailing Address - Zip Code:65591-7564
Mailing Address - Country:US
Mailing Address - Phone:573-692-0960
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-348-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant