Provider Demographics
NPI:1609632355
Name:QUAIL, ANTHONY (LAC, EAMP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:QUAIL
Suffix:
Gender:M
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 SW 152ND ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2029
Mailing Address - Country:US
Mailing Address - Phone:734-417-4163
Mailing Address - Fax:
Practice Address - Street 1:6363 7TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-3407
Practice Address - Country:US
Practice Address - Phone:206-517-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61530831171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist