Provider Demographics
NPI:1164063467
Name:QUINLAN, STEVEN JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAMES
Last Name:QUINLAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2309
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2309
Mailing Address - Country:US
Mailing Address - Phone:509-454-8888
Mailing Address - Fax:
Practice Address - Street 1:111 S 11TH AVE STE 320
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3273
Practice Address - Country:US
Practice Address - Phone:509-454-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61004098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT61004098OtherWASHINGTON STATE PT LICENSE
WA2142382Medicaid