Provider Demographics
NPI:1497729974
Name:QUILTY, TRUDY ANGELA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:TRUDY
Middle Name:ANGELA
Last Name:QUILTY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ROCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4452
Mailing Address - Country:US
Mailing Address - Phone:864-430-5015
Mailing Address - Fax:
Practice Address - Street 1:440 ROPER MOUNTAIN RD
Practice Address - Street 2:SUITE H2
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4242
Practice Address - Country:US
Practice Address - Phone:864-284-0056
Practice Address - Fax:864-284-0059
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist