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General NPI Number Information
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NPI Number | 1609260850
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Entity Type | Individual
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Provider Name | QUENNIE SUNGCAD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 1101 W LIBERTY ST
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City | FARMINGTON
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State | MO
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Zip | 63640-1921
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Country | US
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Telephone | 573-760-8450
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Fax |
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Provider Business Mailing Address
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Address Line | 501 ADAMS ST
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City | PARK HILLS
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State | MO
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Zip | 63601-2207
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Country | US
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Telephone | 573-953-3460
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2011013295
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License Number State | MO
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