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General NPI Number Information
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NPI Number | 1932169851
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH MINIELLO ATC
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Gender | Female
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5400 RAMSEY ST
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-1420
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Country | US
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Telephone | 910-630-7597
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Fax |
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Provider Business Mailing Address
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Address Line | 5559 LINKWOOD DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28311-0287
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Country | US
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Telephone | 910-987-1696
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0892
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License Number State | NC
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