Provider Demographics
NPI:1881929867
Name:MINOR, GLORIA SHARON (LMT, MMP)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:SHARON
Last Name:MINOR
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1017 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-2919
Mailing Address - Country:US
Mailing Address - Phone:937-778-0190
Mailing Address - Fax:
Practice Address - Street 1:110 S STANFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2331
Practice Address - Country:US
Practice Address - Phone:937-339-1988
Practice Address - Fax:937-339-1996
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33. 01750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist