Provider Demographics
NPI:1912607623
Name:QUINN, ALESHA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALESHA
Middle Name:MARIE
Last Name:QUINN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3867 MALIKI DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8694
Mailing Address - Country:US
Mailing Address - Phone:901-721-8351
Mailing Address - Fax:
Practice Address - Street 1:111 USSERY RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4530
Practice Address - Country:US
Practice Address - Phone:931-647-0269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist