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General NPI Number Information
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NPI Number | 1861591893
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Entity Type | Individual
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Provider Name | TARA QUINTON MPT
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1701 PARK AVE
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City | ORANGE PARK
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State | FL
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Zip | 32073-4946
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Country | US
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Telephone | 904-269-8662
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Fax | 904-269-8839
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Provider Business Mailing Address
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Address Line | 9429 HUNSTON MILL LN
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City | JACKSONVILLE
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State | FL
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Zip | 32244-8423
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Country | US
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Telephone | 904-803-6425
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Fax | 904-908-9665
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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 | PT20694
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License Number State | FL
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