Healthcare Provider Details

I. General information

NPI: 1033074398
Provider Name (Legal Business Name): AILEEN QUINN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 CENTINELA AVE
SANTA MONICA CA
90404-4203
US

IV. Provider business mailing address

3931 69TH ST APT A
SACRAMENTO CA
95820-3441
US

V. Phone/Fax

Practice location:
  • Phone: 310-573-9553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: