Provider Demographics
NPI:1346480712
Name:MINNELLA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MINNELLA PHYSICAL THERAPY, LLC
Other - Org Name:INERTIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:973-919-4862
Mailing Address - Street 1:217 BUCHANAN AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08010-2109
Mailing Address - Country:US
Mailing Address - Phone:973-919-4862
Mailing Address - Fax:866-699-1796
Practice Address - Street 1:217 BUCHANAN AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER PARK
Practice Address - State:NJ
Practice Address - Zip Code:08010-2109
Practice Address - Country:US
Practice Address - Phone:973-919-4862
Practice Address - Fax:866-699-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01021500261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy