Healthcare Provider Details

I. General information

NPI: 1437384849
Provider Name (Legal Business Name): MINDY DALE LONGENBACH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 LINCOLN DR
MACUNGIE PA
18062-9243
US

IV. Provider business mailing address

7007 LINCOLN DR
MACUNGIE PA
18062-9243
US

V. Phone/Fax

Practice location:
  • Phone: 610-967-4748
  • Fax:
Mailing address:
  • Phone: 610-967-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE1001731
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: