Healthcare Provider Details

I. General information

NPI: 1346490794
Provider Name (Legal Business Name): BRIAN GARY MCQUILKIN D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 19TH ST NW SUITE 200
ROCHESTER MN
55901-6606
US

IV. Provider business mailing address

PO BOX 7197
ROCHESTER MN
55903-7197
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax: 507-322-3450
Mailing address:
  • Phone: 800-287-0171
  • Fax: 800-287-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7966
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: