Provider Demographics
NPI:1992220784
Name:QUINLAN, HALEY LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:LEIGH
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 RALPH MCGILL BLVD NE APT 2692
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1149
Mailing Address - Country:US
Mailing Address - Phone:517-883-1209
Mailing Address - Fax:
Practice Address - Street 1:1631 RICHWOOD DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3605
Practice Address - Country:US
Practice Address - Phone:678-386-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0120312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics