Provider Demographics
NPI:1760948830
Name:QUINNAN, AMY RUTH (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RUTH
Last Name:QUINNAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RUTH
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11138 FIELDCREST MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-3666
Mailing Address - Country:US
Mailing Address - Phone:248-496-9953
Mailing Address - Fax:
Practice Address - Street 1:44201 DEQUINDRE RD STE 203A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-4014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019041225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist