Provider Demographics
NPI:1295384055
Name:QUINN, HEATHER ELYSE (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELYSE
Last Name:QUINN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ELYSE
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1868 PLAUDIT PL STE B
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2429
Mailing Address - Country:US
Mailing Address - Phone:502-426-2221
Mailing Address - Fax:502-426-2210
Practice Address - Street 1:11330 MAPLE BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2080
Practice Address - Country:US
Practice Address - Phone:502-426-2221
Practice Address - Fax:502-426-2210
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist