Provider Demographics
NPI:1235346412
Name:MINCARELLI, DENISE SUE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:SUE
Last Name:MINCARELLI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:21 JENKINSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-4234
Mailing Address - Country:US
Mailing Address - Phone:845-485-5087
Mailing Address - Fax:
Practice Address - Street 1:243 NORTH RD
Practice Address - Street 2:SUITE 101 THE MEDICAL ARTS BUILDING
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-485-5087
Practice Address - Fax:845-485-4904
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002587-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant