Basic Information
| Provider Information | |||||||||
| NPI: | 1366977001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | EVAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22249 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100870001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0165463972 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8050 SPYGLASS HILL RD | ||||||||
| Address2: | |||||||||
| City: | VIERA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329407983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016546397 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2017 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | MT212681 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208100000X | 148903 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.