MEDICARE: MR. MALIK MINTER PT, 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	1390055	TX

General Provider Information

NPI Number	:	1699533273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MALIK MINTER PT, DPT

Provider Business Mailing Address
First Line	:	9525 N BEACH ST STE 413
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6438
Country	:	US
Telephone Number	:	817-756-9892
Fax Number	:	817-502-7412

Provider Business Practice Location Address
First Line	:	9525 N BEACH ST STE 413
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6438
Country	:	US
Telephone Number	:	817-756-9892
Fax Number	:	817-502-7412

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

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/08/2024

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Directions to “ MR. MALIK MINTER PT, DPT” Practice Location

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