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NPI Code Detail

MEDICARE: SHANAIRRA C QUINN

MEDICARE: SHANAIRRA C QUINN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant
2225200000XPhysical Therapy Assistant2145092TX
3225200000XPhysical Therapy Assistant50261CA

General Provider Information

NPI Number : 1215342613
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANAIRRA C QUINN
Provider Business Mailing Address
First Line : 811 W 2ND ST
Second Line :
City : BYRON
State : IL
Zip : 61010-1464
Country : US
Telephone Number : 815-234-2511
Fax Number :
Provider Business Practice Location Address
First Line : 811 W 2ND ST
Second Line :
City : BYRON
State : IL
Zip : 61010-1464
Country : US
Telephone Number : 815-234-2511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2014
Last Update Date : 09/27/2019

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Directions to “ SHANAIRRA C QUINN ” Practice Location

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