Healthcare Provider Details

I. General information

NPI: 1770526915
Provider Name (Legal Business Name): LANCE THOMAS QUINN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FLORAL VALE BLVD
YARDLEY PA
19067-5522
US

IV. Provider business mailing address

45 ARDSLEY CT
NEWTOWN PA
18940-2300
US

V. Phone/Fax

Practice location:
  • Phone: 215-860-4270
  • Fax: 215-860-2270
Mailing address:
  • Phone: 215-504-1519
  • Fax: 215-860-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016433
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: