Provider Demographics
NPI:1346490794
Name:MCQUILKIN, BRIAN GARY (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:GARY
Last Name:MCQUILKIN
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 7197
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55903-7197
Mailing Address - Country:US
Mailing Address - Phone:800-287-0171
Mailing Address - Fax:800-287-9315
Practice Address - Street 1:3100 19TH ST NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6606
Practice Address - Country:US
Practice Address - Phone:507-322-3460
Practice Address - Fax:507-322-3450
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN79662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic