Provider Demographics
NPI:1194298216
Name:QUINN, COURTNEY (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 ROYAL TERN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6085
Mailing Address - Country:US
Mailing Address - Phone:256-393-2174
Mailing Address - Fax:
Practice Address - Street 1:6233 ROYAL TERN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6085
Practice Address - Country:US
Practice Address - Phone:256-393-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL30322081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine