Provider Demographics
NPI:1134622137
Name:MARIANNO, QUINN
Entity type:Individual
Prefix:
First Name:QUINN
Middle Name:
Last Name:MARIANNO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 E HOLLAND AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1246
Mailing Address - Country:US
Mailing Address - Phone:509-342-3251
Mailing Address - Fax:509-342-3280
Practice Address - Street 1:605 E HOLLAND AVE STE 112
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1246
Practice Address - Country:US
Practice Address - Phone:509-342-3251
Practice Address - Fax:509-342-3280
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-5132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID160151292OtherREGENCE