Provider Demographics
NPI:1265455000
Name:QUINN, JOHN E (MS, PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:QUINN
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4093 BOND CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1630
Mailing Address - Country:US
Mailing Address - Phone:850-729-1280
Mailing Address - Fax:
Practice Address - Street 1:623 HARBOR BLVD
Practice Address - Street 2:SUITE # 5
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2466
Practice Address - Country:US
Practice Address - Phone:850-654-8588
Practice Address - Fax:850-654-8758
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6852Medicare ID - Type Unspecified