Healthcare Provider Details

I. General information

NPI: 1366410078
Provider Name (Legal Business Name): STEPHEN J MINNING MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 SCIOTO HALL, ROOM 108
CINCINNATI OH
45221-0001
US

IV. Provider business mailing address

1076 IVORYHILL DR
INDEPENDENCE KY
41051-9697
US

V. Phone/Fax

Practice location:
  • Phone: 513-556-3178
  • Fax:
Mailing address:
  • Phone: 859-760-3846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number10890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: