Provider Demographics
NPI:1770679649
Name:QUAINTANCE, MCKENSIE L (PT)
Entity Type:Individual
Prefix:MS
First Name:MCKENSIE
Middle Name:L
Last Name:QUAINTANCE
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 1:3642 COUNTY ROAD 23
Mailing Address - Street 2:
Mailing Address - City:BURGOON
Mailing Address - State:OH
Mailing Address - Zip Code:43407-9729
Mailing Address - Country:US
Mailing Address - Phone:419-447-7203
Mailing Address - Fax:419-447-5577
Practice Address - Street 1:600 N BRUSH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1402
Practice Address - Country:US
Practice Address - Phone:419-334-9521
Practice Address - Fax:419-334-5803
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH010793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist