Provider Demographics
NPI:1053441337
Name:QUINN, MIKE (MAT, ATC)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:QUINN
Suffix:
Gender:M
Credentials:MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2919
Mailing Address - Country:US
Mailing Address - Phone:859-816-1093
Mailing Address - Fax:
Practice Address - Street 1:105 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-2919
Practice Address - Country:US
Practice Address - Phone:859-816-1093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer