Provider Demographics
NPI:1780897801
Name:QUINN, SEAN C (MPT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:C
Last Name:QUINN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 ROCKWOOD PLACE CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1158
Mailing Address - Country:US
Mailing Address - Phone:636-938-4065
Mailing Address - Fax:636-938-4067
Practice Address - Street 1:70 E NORTH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-1205
Practice Address - Country:US
Practice Address - Phone:636-938-4065
Practice Address - Fax:636-938-4067
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001005492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11299OtherESSENCE
MO861105238001OtherTRICARE
MO227075OtherGHP
MO227075OtherCMR
MO7889614OtherAETNA
MO6400737OtherUNITED HEALTH CARE
MO683038OtherHEALTHLINK
MO193453OtherBLUE CROSS BLUE SHIELD
MO683038OtherHEALTHLINK