Provider Demographics
NPI:1023071909
Name:QUINN, JACQUELINE MICHELLE (MPT)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:QUINN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 HONOR PL
Mailing Address - Street 2:
Mailing Address - City:COTATI
Mailing Address - State:CA
Mailing Address - Zip Code:94931-5356
Mailing Address - Country:US
Mailing Address - Phone:707-793-9580
Mailing Address - Fax:
Practice Address - Street 1:169 LYNCH CREEK WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2344
Practice Address - Country:US
Practice Address - Phone:707-763-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist