Healthcare Provider Details

I. General information

NPI: 1861538241
Provider Name (Legal Business Name): SARAH A MINTEN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 S MAIN ST STE 120
FOND DU LAC WI
54935-6116
US

IV. Provider business mailing address

N176 CROOKED PINE CT
APPLETON WI
54915-3990
US

V. Phone/Fax

Practice location:
  • Phone: 920-322-0447
  • Fax:
Mailing address:
  • Phone: 920-954-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: