Provider Demographics
NPI:1699100719
Name:MINWEASER, TONYA LEE (PTA)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:LEE
Last Name:MINWEASER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 HUGHEY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-5648
Mailing Address - Country:US
Mailing Address - Phone:814-849-0552
Mailing Address - Fax:
Practice Address - Street 1:133 LAURELBROOKE DR
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-2653
Practice Address - Country:US
Practice Address - Phone:814-849-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1002924225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant