Basic Information
| Provider Information | |||||||||
| NPI: | 1457421745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUINN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | D | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DRAKE | ||||||||
| OtherFirstName: | PAMELA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 2170 | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983900480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538402313 | ||||||||
| FaxNumber: | 2538406340 | ||||||||
| Practice Location | |||||||||
| Address1: | 3015 LIMITED LN NW | ||||||||
| Address2: | SUITE B | ||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985022638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607090700 | ||||||||
| FaxNumber: | 3607090703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 06/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00009589 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8874DR | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8939680 | 01 | WA | CRIME VICTIMS | OTHER | 8413866 | 05 | WA | MEDICAID | 192270 | 01 | WA | DEPT OF LABOR & INDUSTRY | OTHER |