Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5793 | SC |
NPI | 1396069167 |
---|---|
Provider Name | Ms. Quinndolyn Mcinnis |
First Address | Charlotte, NC 28278-8766 |
Second Address | Rock Hill, SC 29732-2315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2010 |
Last Update Date | 22/03/2010 |