Healthcare Provider Details

I. General information

NPI: 1407261720
Provider Name (Legal Business Name): JESSICA MINACAPELLI MIELE D.P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 CAMPBELL BLVD SUITE 130A
NOTTINGHAM MD
21236-5908
US

IV. Provider business mailing address

4924 CAMPBELL BLVD SUITE 130A
NOTTINGHAM MD
21236-5908
US

V. Phone/Fax

Practice location:
  • Phone: 443-442-2050
  • Fax: 443-442-2054
Mailing address:
  • Phone: 443-442-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25041
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: