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General NPI Number Information
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NPI Number | 1104004050
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Entity Type | Individual
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Provider Name | ELIZABETH ANN QUINTAS MINICUCCI PT, DPT, PRPC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2008
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 401 CAMPUS BLVD
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City | WINCHESTER
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State | VA
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Zip | 22601-2800
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Country | US
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Telephone | 540-536-3011
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Fax |
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Provider Business Mailing Address
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Address Line | 232 OLD WILSON CT
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City | HIGH VIEW
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State | WV
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Zip | 26808-4501
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 017477
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 007635
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License Number State | CT
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