Healthcare Provider Details

I. General information

NPI: 1548443096
Provider Name (Legal Business Name): ELYSE QUARTINI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 07/04/2023
Certification Date: 07/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 RANDOLPH RD STE 105
CHARLOTTE NC
28211-1365
US

IV. Provider business mailing address

2401 EUCLID AVE UNIT 207
CHARLOTTE NC
28203-6779
US

V. Phone/Fax

Practice location:
  • Phone: 415-377-5419
  • Fax:
Mailing address:
  • Phone: 415-377-5419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberP21843
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number34109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: