Provider Demographics
NPI:1942414743
Name:QUINN PHYSICAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:QUINN PHYSICAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-856-2970
Mailing Address - Street 1:127 WALMART DR
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-8435
Mailing Address - Country:US
Mailing Address - Phone:706-856-2970
Mailing Address - Fax:706-856-2972
Practice Address - Street 1:127 WALMART DR
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-8435
Practice Address - Country:US
Practice Address - Phone:706-856-2970
Practice Address - Fax:706-856-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7475Medicare ID - Type UnspecifiedGROUP NUMBER
GADE2951Medicare ID - Type UnspecifiedMEDICARE RAILROAD GROUP #
GAP00283686Medicare PIN
GAQ57515Medicare UPIN