Provider Demographics
NPI:1629007828
Name:MINNEHAN, PETER JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:MINNEHAN
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:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03263-0367
Mailing Address - Country:US
Mailing Address - Phone:603-226-3500
Mailing Address - Fax:603-226-3420
Practice Address - Street 1:PO BOX 367
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:NH
Practice Address - Zip Code:03263-0367
Practice Address - Country:US
Practice Address - Phone:603-226-3500
Practice Address - Fax:603-226-3420
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNA1218OtherHARVARD
NH0806594Y0NH01OtherBLUE CROSS
NH40002952Medicaid
NHNA1218OtherHARVARD