Provider Demographics
NPI:1962680546
Name:QUINONES, CYRUS J (PT)
Entity Type:Individual
Prefix:
First Name:CYRUS
Middle Name:J
Last Name:QUINONES
Suffix:
Gender:M
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:PO BOX 3497
Mailing Address - Street 2:
Mailing Address - City:STURTEVANT
Mailing Address - State:WI
Mailing Address - Zip Code:53177-0300
Mailing Address - Country:US
Mailing Address - Phone:877-552-2996
Mailing Address - Fax:866-245-8064
Practice Address - Street 1:300 S KOELLER ST
Practice Address - Street 2:SUITE G
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-5590
Practice Address - Country:US
Practice Address - Phone:920-231-5195
Practice Address - Fax:920-231-5196
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4180225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist