Provider Demographics
NPI:1407820079
Name:MINNELLA, GARY FRANCIS (LAT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:FRANCIS
Last Name:MINNELLA
Suffix:
Gender:M
Credentials:LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9008 E PINE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-7954
Mailing Address - Country:US
Mailing Address - Phone:810-841-7533
Mailing Address - Fax:
Practice Address - Street 1:9008 E PINE VALLEY DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-7954
Practice Address - Country:US
Practice Address - Phone:810-841-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0010962255A2300X
AZ10962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer