Healthcare Provider Details

I. General information

NPI: 1194298216
Provider Name (Legal Business Name): COURTNEY QUINN MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6233 ROYAL TERN ST
ORLANDO FL
32810-6085
US

IV. Provider business mailing address

6233 ROYAL TERN ST
ORLANDO FL
32810-6085
US

V. Phone/Fax

Practice location:
  • Phone: 256-393-2174
  • Fax:
Mailing address:
  • Phone: 256-393-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAL3032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: