Provider Demographics
NPI:1518209584
Name:FLUELLEN, QUIANA T (PT)
Entity Type:Individual
Prefix:MRS
First Name:QUIANA
Middle Name:T
Last Name:FLUELLEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:QUIANA
Other - Middle Name:T
Other - Last Name:HOLSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2911 GEORGE BUSBEE PKWY NW STE 50
Mailing Address - Street 2:SUITE 50
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6910
Mailing Address - Country:US
Mailing Address - Phone:844-328-4624
Mailing Address - Fax:770-882-2576
Practice Address - Street 1:2911 GEORGE BUSBEE PKWY NW STE 50
Practice Address - Street 2:SUITE 50
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6910
Practice Address - Country:US
Practice Address - Phone:844-328-4624
Practice Address - Fax:770-882-2576
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010942225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist