Provider Demographics
NPI:1992801427
Name:MINARD, STEPHEN J (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:J
Last Name:MINARD
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PROVIDENCE HWY
Mailing Address - Street 2:DHAC PHYSICAL THERAPY
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-326-8372
Mailing Address - Fax:
Practice Address - Street 1:200 PROVIDENCE HWY
Practice Address - Street 2:DHAC PHYSICAL THERAPY
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026
Practice Address - Country:US
Practice Address - Phone:781-326-8372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13275 PHYSICAL THERA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA468119OtherTUFTS
817690OtherAETNA
613720OtherHARVARD PILGRIM HEALTH CA
MAY67786OtherBLUE CROSS BLUE SHIELD
6400217OtherUNITED HEALTH CARE
MA468119OtherTUFTS