Provider Demographics
NPI:1669643516
Name:QUALLS, JOELLEN K (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOELLEN
Middle Name:K
Last Name:QUALLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1806 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-4206
Mailing Address - Country:US
Mailing Address - Phone:806-288-7891
Mailing Address - Fax:806-288-7920
Practice Address - Street 1:4601 66TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4828
Practice Address - Country:US
Practice Address - Phone:806-793-3900
Practice Address - Fax:806-793-3937
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist