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General NPI Number Information
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NPI Number | 1235384512
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Entity Type | Individual
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Provider Name | DOLORES CAROL QUICK PTA
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Gender | Female
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Dates
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Enumeration Date | 11/30/2008
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Last Update Date | 11/30/2008
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Provider Practice Location Address
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Address Line | 815 S WALNUT AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-5956
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Country | US
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Telephone | 931-528-5516
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Fax |
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Provider Business Mailing Address
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Address Line | 432 MADDUX RD
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City | COOKEVILLE
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State | TN
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Zip | 38501-9705
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Country | US
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Telephone | 931-525-6894
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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 | 4406
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License Number State | TN
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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 | 19533
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License Number State | FL
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