Healthcare Provider Details

I. General information

NPI: 1871727800
Provider Name (Legal Business Name): MINA CAUTHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 LAKE ARTHUR DR
PORT ARTHUR TX
77642-6490
US

IV. Provider business mailing address

11403 CEDAR GULLY RD
BEACH CITY TX
77523-8280
US

V. Phone/Fax

Practice location:
  • Phone: 409-722-0714
  • Fax: 409-722-0714
Mailing address:
  • Phone: 281-413-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2058681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: