MEDICARE: CHRISTOPHER MICHAEL MINNIS DPT

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
2	2251X0800X	Orthopedic Physical Therapist	294806	CA
3	225100000X	Physical Therapist	294806	CA

General Provider Information

NPI Number	:	1043740749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MICHAEL MINNIS DPT

Provider Business Mailing Address
First Line	:	362 CHINQUAPIN AVE
Second Line	:	UNIT 4
City	:	CARLSBAD
State	:	CA
Zip	:	92008
Country	:	US
Telephone Number	:	732-567-0790
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 OCEAN RANCH BLVD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-2669
Country	:	US
Telephone Number	:	760-696-3376
Fax Number	:	877-559-5308

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

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	03/10/2023

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