MEDICARE: MRS. ANTARA DORIS QUINONES DPT

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
1	225100000X	Physical Therapist		MT
2	225100000X	Physical Therapist	4356	MT

General Provider Information

NPI Number	:	1649538893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANTARA DORIS QUINONES DPT

Provider Business Mailing Address
First Line	:	5000 BLUE MOUNTAIN RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-9213
Country	:	US
Telephone Number	:	406-251-2323
Fax Number	:	406-251-2999

Provider Business Practice Location Address
First Line	:	2965 STOCKYARD RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1557
Country	:	US
Telephone Number	:	406-541-2606
Fax Number	:	406-541-2607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	11/05/2014

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