Provider Demographics
NPI:1871727800
Name:CAUTHEN, MINA
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:CAUTHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11403 CEDAR GULLY RD
Mailing Address - Street 2:
Mailing Address - City:BEACH CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77523-8280
Mailing Address - Country:US
Mailing Address - Phone:281-413-8015
Mailing Address - Fax:
Practice Address - Street 1:4225 LAKE ARTHUR DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6490
Practice Address - Country:US
Practice Address - Phone:409-722-0714
Practice Address - Fax:409-722-0714
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2058681225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant