Basic Information
| Provider Information | |||||||||
| NPI: | 1144226002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUINTAL | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | LUCIA | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 585 SUGAR VALLEY TRL SE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300943825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709293279 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1603 HIGHWAY 20 NE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300123736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709298411 | ||||||||
| FaxNumber: | 7709181419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT20563 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 008905 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.