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NPI Code Detail

MEDICARE: MR. GARY FRANCIS MINNELLA LAT, CSCS

MEDICARE: MR. GARY FRANCIS MINNELLA LAT, CSCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerATR-001096AZ

General Provider Information

NPI Number : 1407820079
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY FRANCIS MINNELLA LAT, CSCS
Provider Business Mailing Address
First Line : 9008 E PINE VALLEY DR
Second Line :
City : TUCSON
State : AZ
Zip : 85710-7954
Country : US
Telephone Number : 810-841-7533
Fax Number :
Provider Business Practice Location Address
First Line : 9008 E PINE VALLEY DR
Second Line :
City : TUCSON
State : AZ
Zip : 85710-7954
Country : US
Telephone Number : 810-841-7533
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 05/02/2026

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