Provider Demographics
NPI:1609267913
Name:FREEDOM PHYSICAL THERAPY AND TRAINING CENTER PA
Entity Type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY AND TRAINING CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:DEQUINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:408-489-3836
Mailing Address - Street 1:7740 HEDGE LANE TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66227-3017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7740 HEDGE LANE TER
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66227-3017
Practice Address - Country:US
Practice Address - Phone:913-745-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy