Provider Demographics
NPI:1467676023
Name:QUINTANA, MIGUEL A JR (PT)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:QUINTANA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SE 18TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8212
Mailing Address - Country:US
Mailing Address - Phone:352-789-6776
Mailing Address - Fax:352-390-6359
Practice Address - Street 1:1901 SE 18TH AVE
Practice Address - Street 2:STE 102
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-789-6776
Practice Address - Fax:352-390-6359
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT222152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBK661ZMedicare PIN