Healthcare Provider Details

I. General information

NPI: 1588610141
Provider Name (Legal Business Name): WILLIAM CAMERON MINNICH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 ROUTE 202 BLDG 2
SOMERS NY
10589-3253
US

IV. Provider business mailing address

339 ROUTE 202 BLDG 2
SOMERS NY
10589-3253
US

V. Phone/Fax

Practice location:
  • Phone: 914-617-8211
  • Fax: 914-617-8213
Mailing address:
  • Phone: 914-617-8211
  • Fax: 914-617-8213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number020539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: