Provider Demographics
NPI:1568702165
Name:MINONG, FLORENTINA BAENTO (PT)
Entity Type:Individual
Prefix:
First Name:FLORENTINA
Middle Name:BAENTO
Last Name:MINONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LILLIAN CT
Mailing Address - Street 2:
Mailing Address - City:WANTAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-3018
Mailing Address - Country:US
Mailing Address - Phone:425-988-4368
Mailing Address - Fax:
Practice Address - Street 1:28 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:NJ
Practice Address - Zip Code:07832-2324
Practice Address - Country:US
Practice Address - Phone:908-914-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA014742002251G0304X
NY0291142251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics