Healthcare Provider Details

I. General information

NPI: 1942412424
Provider Name (Legal Business Name): KATHRYN A QUINLAN MPT, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN A MANGER MPT,ATC,LAT

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6626 GORDON RD STE H
WILMINGTON NC
28411-8424
US

IV. Provider business mailing address

1112 TRADITIONAL LN
WILMINGTON NC
28411-5601
US

V. Phone/Fax

Practice location:
  • Phone: 910-798-4051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number000247
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008467
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP17276
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: