Healthcare Provider Details

I. General information

NPI: 1295880326
Provider Name (Legal Business Name): JAMES M MINELLA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 OAKWOOD DR
OLD FORGE PA
18518-1250
US

IV. Provider business mailing address

12 OAKWOOD DR
OLD FORGE PA
18518-1250
US

V. Phone/Fax

Practice location:
  • Phone: 570-498-3546
  • Fax:
Mailing address:
  • Phone: 570-498-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013533L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: