Provider Demographics
NPI:1386620219
Name:QUINN, MARY THERESA (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:THERESA
Last Name:QUINN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:11547-0274
Mailing Address - Country:US
Mailing Address - Phone:516-628-2008
Mailing Address - Fax:516-676-1449
Practice Address - Street 1:136 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:GLENWOOD LANDING
Practice Address - State:NY
Practice Address - Zip Code:11547-0274
Practice Address - Country:US
Practice Address - Phone:516-676-1445
Practice Address - Fax:516-676-1449
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY107092251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ75522Medicare ID - Type UnspecifiedPHYSICAL THERAPIST