Provider Demographics
NPI:1962903286
Name:MINNETTE, CAROLYN SUAREZ
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUAREZ
Last Name:MINNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 MILLS RD
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1126
Mailing Address - Country:US
Mailing Address - Phone:734-944-0068
Mailing Address - Fax:
Practice Address - Street 1:440 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1184
Practice Address - Country:US
Practice Address - Phone:734-429-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist