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General NPI Number Information
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NPI Number | 1063802163
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Entity Type | Individual
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Provider Name | SAMANTHA QUISENBERRY
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Gender | Female
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 201 SANDPOINTE AVE SUITE 130
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City | SANTA ANA
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State | CA
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Zip | 92707-5778
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Country | US
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Telephone | 714-557-9292
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Fax |
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Provider Business Mailing Address
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Address Line | 120 CALLE AMISTAD UNIT 5104
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6917
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Country | US
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Telephone | 949-945-4788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT10655
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License Number State | CA
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