Provider Demographics
NPI:1770041105
Name:QUINTAR, FAISAL ALEJANDRO (RPT)
Entity Type:Individual
Prefix:
First Name:FAISAL
Middle Name:ALEJANDRO
Last Name:QUINTAR
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10152 COSTA DEL SOL BLVD
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2354
Mailing Address - Country:US
Mailing Address - Phone:786-370-2476
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 36TH ST STE 31
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6649
Practice Address - Country:US
Practice Address - Phone:305-418-2385
Practice Address - Fax:305-418-1888
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102229100Medicaid