Provider Demographics
NPI:1942412424
Name:QUINLAN, KATHRYN A (MPT, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:MPT, ATC, LAT
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:MANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT,ATC,LAT
Mailing Address - Street 1:1112 TRADITIONAL LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-5601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6626 GORDON RD STE H
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8424
Practice Address - Country:US
Practice Address - Phone:910-798-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002472081S0010X
CT008467225100000X
NCP17276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11931376OtherCAQH