Provider Demographics
NPI:1174192835
Name:QUICK, HALIE (DPT)
Entity Type:Individual
Prefix:
First Name:HALIE
Middle Name:
Last Name:QUICK
Suffix:
Gender:F
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 1772
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-7772
Mailing Address - Country:US
Mailing Address - Phone:850-682-7772
Mailing Address - Fax:888-308-1539
Practice Address - Street 1:4554 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9755
Practice Address - Country:US
Practice Address - Phone:850-897-7772
Practice Address - Fax:888-308-1539
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist