Provider Demographics
NPI:1457421745
Name:QUINN, PAMELA D (DPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:QUINN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:A
Other - Last Name:DRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-0480
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:3015 LIMITED LN NW
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2638
Practice Address - Country:US
Practice Address - Phone:360-709-0700
Practice Address - Fax:360-709-0703
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8874DROtherREGENCE BLUE SHIELD
WA8939680OtherCRIME VICTIMS
WA8413866Medicaid
WA192270OtherDEPT OF LABOR & INDUSTRY
WA192270OtherDEPT OF LABOR & INDUSTRY
WA8413866Medicaid