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NPI Code Detail

MEDICARE: ANDREW DONALD MINER

MEDICARE: ANDREW DONALD MINER
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
1225100000XPhysical TherapistNE3106NE

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NA1822004OTHERNEMEDICARE

General Provider Information

NPI Number : 1548515919
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW DONALD MINER
Provider Business Mailing Address
First Line : 2030 RAINBOW AVE
Second Line :
City : SEWARD
State : NE
Zip : 68434-3000
Country : US
Telephone Number : 402-643-0711
Fax Number :
Provider Business Practice Location Address
First Line : 1104 GRUNDMAN BLVD
Second Line :
City : NEBRASKA CITY
State : NE
Zip : 68410-3397
Country : US
Telephone Number : 402-873-7411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2012
Last Update Date : 12/27/2012

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