Provider Demographics
NPI:1205953668
Name:QUINNAN, LISA M (PT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:QUINNAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1658 FRANKLIN WAY
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6315
Mailing Address - Country:US
Mailing Address - Phone:570-575-4024
Mailing Address - Fax:
Practice Address - Street 1:7101 DR M.L.K. JR STREET N
Practice Address - Street 2:
Practice Address - City:ST.PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702
Practice Address - Country:US
Practice Address - Phone:727-527-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-007330-L225100000X
FL34471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34471OtherPHYSICAL THERAPY LICENSE FLORIDA
PAPT-007330-LOtherPT LICENSE NUMBER