Provider Demographics
NPI:1194269951
Name:RICE, QUENTIN (LMT, PHTC)
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:
Last Name:RICE
Suffix:
Gender:M
Credentials:LMT, PHTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 PERSIMMON ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-5938
Mailing Address - Country:US
Mailing Address - Phone:614-701-7317
Mailing Address - Fax:
Practice Address - Street 1:1918 W FABYAN PKWY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1215
Practice Address - Country:US
Practice Address - Phone:630-482-2485
Practice Address - Fax:630-482-2531
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022342225700000X
IL049.263898183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist