Provider Demographics
NPI:1750460911
Name:QUIRK, LAURA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:QUIRK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 BELLE MEAD RD
Mailing Address - Street 2:STE 2 AND 3
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3477
Mailing Address - Country:US
Mailing Address - Phone:631-941-3535
Mailing Address - Fax:631-341-3599
Practice Address - Street 1:196 BELLE MEAD RD
Practice Address - Street 2:STE 2 AND 3
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3477
Practice Address - Country:US
Practice Address - Phone:631-941-3535
Practice Address - Fax:631-341-3599
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0110991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQM5521Medicare ID - Type Unspecified