Provider Demographics
NPI:1144980111
Name:MCQUINN, BRYAN (PTA)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:MCQUINN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70689
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84170-0689
Mailing Address - Country:US
Mailing Address - Phone:801-987-8600
Mailing Address - Fax:
Practice Address - Street 1:1100 SOUTHGATE STE 15
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3971
Practice Address - Country:US
Practice Address - Phone:541-276-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant