Provider Demographics
NPI:1457032419
Name:QUINTA PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:QUINTA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIETHER PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-396-1017
Mailing Address - Street 1:7402 GRAND AVE # 3A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4127
Mailing Address - Country:US
Mailing Address - Phone:917-396-1017
Mailing Address - Fax:917-396-1018
Practice Address - Street 1:7402 GRAND AVE # 3A
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4127
Practice Address - Country:US
Practice Address - Phone:917-396-1017
Practice Address - Fax:917-396-1018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty