Provider Demographics
NPI:1316176779
Name:QUINN, WILLIAM (LMT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PINETREE DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4444
Mailing Address - Country:US
Mailing Address - Phone:321-863-2736
Mailing Address - Fax:
Practice Address - Street 1:1300 PINETREE DR
Practice Address - Street 2:SUITE 6
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4444
Practice Address - Country:US
Practice Address - Phone:321-863-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45740225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist