Healthcare Provider Details

I. General information

NPI: 1922377407
Provider Name (Legal Business Name): ANDREW MINARDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S HICKORY ST
MOUNT VERNON MO
65712-2045
US

IV. Provider business mailing address

PO BOX 383
WARSAW MO
65355-0383
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-7103
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: