Provider Demographics
NPI:1043415235
Name:BASA, QUENNIE M (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:QUENNIE
Middle Name:M
Last Name:BASA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9353 IMPERIAL HWY
Mailing Address - Street 2:GARDEN MEDICAL OFFICE 3RD FLOOR
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2812
Mailing Address - Country:US
Mailing Address - Phone:562-657-2428
Mailing Address - Fax:
Practice Address - Street 1:9353 IMPERIAL HWY
Practice Address - Street 2:GARDEN MEDICAL OFFICE 3RD FLOOR
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2812
Practice Address - Country:US
Practice Address - Phone:562-657-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA237112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic