Provider Demographics
NPI:1790882892
Name:QUAIL, MINDY L (PT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:L
Last Name:QUAIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:L
Other - Last Name:MESCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 412066
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1738 CELANESE RD STE 102
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1731
Practice Address - Country:US
Practice Address - Phone:803-670-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014958225100000X
SC11257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00635528Medicare PIN
ILK52370Medicare PIN
ILK33500Medicare PIN