Provider Demographics
NPI:1255648705
Name:QUINTOS, EDWARD APOLINARIO (PTA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:APOLINARIO
Last Name:QUINTOS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 EARLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1154
Mailing Address - Country:US
Mailing Address - Phone:626-487-7062
Mailing Address - Fax:
Practice Address - Street 1:1313 W 8TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4420
Practice Address - Country:US
Practice Address - Phone:213-401-1985
Practice Address - Fax:213-401-1987
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8653225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant