Provider Demographics
NPI:1740330612
Name:QUINN, KEVIN EDWARD (PT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:EDWARD
Last Name:QUINN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WALMART DR
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-8435
Mailing Address - Country:US
Mailing Address - Phone:706-856-2970
Mailing Address - Fax:706-856-2972
Practice Address - Street 1:127 WALMART DR
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-8435
Practice Address - Country:US
Practice Address - Phone:706-856-2970
Practice Address - Fax:706-856-2972
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDHGMedicare PIN
GADE2951Medicare ID - Type UnspecifiedMEDICARE RAILROAD GROUP #
GAGRP7475Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
GAQ57515Medicare UPIN
GAP00283686Medicare PIN