Healthcare Provider Details

I. General information

NPI: 1114237831
Provider Name (Legal Business Name): QUANTUM THERAPTUTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 06/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 NE 124 ST
NORTH MIAMI FL
33161
US

IV. Provider business mailing address

640 NE 124 ST
NORTH MIAMI FL
33161
US

V. Phone/Fax

Practice location:
  • Phone: 305-891-4114
  • Fax: 305-891-4114
Mailing address:
  • Phone: 305-891-4114
  • Fax: 305-891-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11443
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3284
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA35742
License Number StateFL

VIII. Authorized Official

Name: LINDA R. CARRINGTON
Title or Position: V.P.
Credential: LMT, AP
Phone: 305-891-4114