Basic Information
| Provider Information | |||||||||
| NPI: | 1790161586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | CAITLIN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CROSS | ||||||||
| OtherFirstName: | CAITLIN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 510 8TH AVE NE STE 340 | ||||||||
| Address2: | |||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980295449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253133055 | ||||||||
| FaxNumber: | 4253133051 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 8TH AVE NE STE 340 | ||||||||
| Address2: | |||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253133055 | ||||||||
| FaxNumber: | 4253133051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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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 | PT60565741 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2047284 | 05 | WA | MEDICAID |