MEDICARE: GI MIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1376027383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GI MIN

Provider Business Mailing Address
First Line	:	10754 SAND CASTLE WAY
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-4272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10754 SAND CASTLE WAY
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-4272
Country	:	US
Telephone Number	:	303-341-2277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	02/04/2026

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Directions to “ GI MIN ” Practice Location

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