Provider Demographics
NPI:1588610141
Name:MINNICH, WILLIAM CAMERON (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CAMERON
Last Name:MINNICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 ROUTE 202 BLDG 2
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3253
Mailing Address - Country:US
Mailing Address - Phone:914-617-8211
Mailing Address - Fax:914-617-8213
Practice Address - Street 1:339 ROUTE 202 BLDG 2
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3253
Practice Address - Country:US
Practice Address - Phone:914-617-8211
Practice Address - Fax:914-617-8213
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ45591Medicare ID - Type UnspecifiedPHYSICAL THERAPIST