Provider Demographics
NPI:1093385171
Name:QUICK, JANAE (LMBT #18243)
Entity Type:Individual
Prefix:MS
First Name:JANAE
Middle Name:
Last Name:QUICK
Suffix:
Gender:F
Credentials:LMBT #18243
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 ZION AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8546
Mailing Address - Country:US
Mailing Address - Phone:704-508-9770
Mailing Address - Fax:
Practice Address - Street 1:20200 ZION AVE STE 3
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8546
Practice Address - Country:US
Practice Address - Phone:704-508-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
555Other555