Provider Demographics
NPI:1225787575
Name:O'QUINN, THOMAS LEONARD (PTA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEONARD
Last Name:O'QUINN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 ASHLEY RIVER RD STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4904
Mailing Address - Country:US
Mailing Address - Phone:843-761-1480
Mailing Address - Fax:843-761-1481
Practice Address - Street 1:1954 ASHLEY RIVER RD STE E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4904
Practice Address - Country:US
Practice Address - Phone:843-761-1480
Practice Address - Fax:843-761-1481
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3799225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant