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General NPI Number Information
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NPI Number | 1184070997
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Entity Type | Individual
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Provider Name | SHANNON QUINTERO PTA
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Gender | Female
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Dates
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Enumeration Date | 05/11/2016
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 101 LIBERTY LN
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City | ANSON
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State | TX
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Zip | 79501-2197
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Country | US
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Telephone | 325-823-2141
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 NW 46TH PL
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City | OCALA
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State | FL
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Zip | 34475-9574
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Country | US
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Telephone | 321-696-5158
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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 | 2167050
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 26913
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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