Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 2251X0800X | Physical Therapist - Orthopedic | 294806 | CA |
NPI | 1043740749 |
---|---|
Provider Name | Christopher Michael Minnis |
First Address | San Francisco, CA 94117-3857 |
Second Address | San Rafael, CA 94901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 10/07/2018 |