Provider Demographics
NPI:1922377209
Name:MINCH, HERBERT PAUL JR (MS, ATC, EMT-P)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:PAUL
Last Name:MINCH
Suffix:JR
Gender:M
Credentials:MS, ATC, EMT-P
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Mailing Address - Street 1:101 FACULTY DRIVE
Mailing Address - Street 2:CSC 103
Mailing Address - City:WEST LIBERTY
Mailing Address - State:WV
Mailing Address - Zip Code:26074
Mailing Address - Country:US
Mailing Address - Phone:304-336-8476
Mailing Address - Fax:304-336-5139
Practice Address - Street 1:101 FACULTY DRIVE
Practice Address - Street 2:CSC 103
Practice Address - City:WEST LIBERTY
Practice Address - State:WV
Practice Address - Zip Code:26074
Practice Address - Country:US
Practice Address - Phone:304-336-8476
Practice Address - Fax:304-336-5139
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
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Provider Licenses
StateLicense IDTaxonomies
WVAT0011342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer