Provider Demographics
NPI:1598755142
Name:QUALE, PAUL M (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:M
Last Name:QUALE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HUNDERTMARK RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1150
Mailing Address - Country:US
Mailing Address - Phone:952-556-2656
Mailing Address - Fax:952-556-2657
Practice Address - Street 1:3000 HUNDERTMARK RD
Practice Address - Street 2:SUITE 10
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1150
Practice Address - Country:US
Practice Address - Phone:952-556-2656
Practice Address - Fax:952-556-2657
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer