Provider Demographics
NPI:1487753224
Name:QUAINTANCE, ROSE RENEE (PT)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:RENEE
Last Name:QUAINTANCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3452 PENINSULA DR
Mailing Address - Street 2:UNIT 11
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368
Mailing Address - Country:US
Mailing Address - Phone:219-331-1025
Mailing Address - Fax:
Practice Address - Street 1:3391 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368
Practice Address - Country:US
Practice Address - Phone:219-762-0821
Practice Address - Fax:219-763-3637
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009025A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist