Provider Demographics
NPI:1154455087
Name:QUINN, KIMBERLY PAIGE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:PAIGE
Last Name:QUINN
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 1:293 GREENE ROAD 606
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-9785
Mailing Address - Country:US
Mailing Address - Phone:870-335-9564
Mailing Address - Fax:870-335-9564
Practice Address - Street 1:293 GREENE ROAD 606
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-9785
Practice Address - Country:US
Practice Address - Phone:870-335-9564
Practice Address - Fax:870-335-9564
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist