Healthcare Provider Details

I. General information

NPI: 1730782426
Provider Name (Legal Business Name): CASEY QUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 WALNUT ST STE 200
PHILADELPHIA PA
19103-5426
US

IV. Provider business mailing address

475 ALLENDALE RD STE 206
KING OF PRUSSIA PA
19406-1495
US

V. Phone/Fax

Practice location:
  • Phone: 215-545-8717
  • Fax: 215-545-9355
Mailing address:
  • Phone: 610-270-0370
  • Fax: 610-270-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018898
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT028751
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: