Provider Demographics
NPI:1386690600
Name:MINA, CHARITO APOLONIO (PT)
Entity type:Individual
Prefix:
First Name:CHARITO
Middle Name:APOLONIO
Last Name:MINA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR
Mailing Address - Street 2:STE 400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-8923
Mailing Address - Fax:423-954-7399
Practice Address - Street 1:3007 NE WEST DEVILS LAKE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-5131
Practice Address - Country:US
Practice Address - Phone:541-994-6252
Practice Address - Fax:541-994-6355
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist