Healthcare Provider Details

I. General information

NPI: 1396069167
Provider Name (Legal Business Name): QUINNDOLYN MCINNIS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 SEDGEWOOD DR
ROCK HILL SC
29732-2315
US

IV. Provider business mailing address

16716 PRAIRIE FALCON LN
CHARLOTTE NC
28278-8766
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-6565
  • Fax:
Mailing address:
  • Phone: 843-729-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5793
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: