Provider Demographics
NPI:1144226002
Name:QUINTAL, MARIA LUCIA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LUCIA
Last Name:QUINTAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 SUGAR VALLEY TRL SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3825
Mailing Address - Country:US
Mailing Address - Phone:770-929-3279
Mailing Address - Fax:
Practice Address - Street 1:1603 HIGHWAY 20 NE
Practice Address - Street 2:SUITE 201
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3736
Practice Address - Country:US
Practice Address - Phone:770-929-8411
Practice Address - Fax:770-918-1419
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20563225100000X
GA008905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist