MEDICARE: LOURDES MARIA QUINONES P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT 17136	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184781015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES MARIA QUINONES P.T.

Provider Business Mailing Address
First Line	:	9528 CITRUS GLEN PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4018
Country	:	US
Telephone Number	:	813-344-0960
Fax Number	:	813-344-0965

Provider Business Practice Location Address
First Line	:	9528 CITRUS GLEN PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4018
Country	:	US
Telephone Number	:	813-344-0960
Fax Number	:	813-344-0965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	01/27/2017

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