Provider Demographics
NPI:1548373699
Name:MINEWEASER, KATHLEEN ANNE (PTA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:MINEWEASER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ORVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221
Mailing Address - Country:US
Mailing Address - Phone:410-686-2270
Mailing Address - Fax:410-686-5447
Practice Address - Street 1:2634 BRANDERMILL BLVD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1651
Practice Address - Country:US
Practice Address - Phone:410-721-7201
Practice Address - Fax:410-721-7580
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2611225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant