Provider Demographics
NPI:1104004050
Name:MINICUCCI, ELIZABETH ANN QUINTAS (PT, DPT, PRPC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN QUINTAS
Last Name:MINICUCCI
Suffix:
Gender:F
Credentials:PT, DPT, PRPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 OLD WILSON CT
Mailing Address - Street 2:
Mailing Address - City:HIGH VIEW
Mailing Address - State:WV
Mailing Address - Zip Code:26808-4501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 CAMPUS BLVD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2800
Practice Address - Country:US
Practice Address - Phone:540-536-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-02
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017477225100000X
CT007635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist