Healthcare Provider Details

I. General information

NPI: 1023465291
Provider Name (Legal Business Name): JUAN RAMON QUILES JR. PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2380 JAMES RD
MEMPHIS TN
38127-8806
US

IV. Provider business mailing address

2054 SATINWOOD DR
MEMPHIS TN
38119-5631
US

V. Phone/Fax

Practice location:
  • Phone: 901-358-1707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number6937
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: