Provider Demographics
NPI:1295880326
Name:MINELLA, JAMES M (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:MINELLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1250
Mailing Address - Country:US
Mailing Address - Phone:570-498-3546
Mailing Address - Fax:
Practice Address - Street 1:12 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:PA
Practice Address - Zip Code:18518-1250
Practice Address - Country:US
Practice Address - Phone:570-498-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013533L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist