Provider Demographics
NPI:1518550342
Name:QUINTANA, DIETHER PAUL OFARIL (DPT)
Entity type:Individual
Prefix:MR
First Name:DIETHER PAUL
Middle Name:OFARIL
Last Name:QUINTANA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3275 44TH ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-2312
Mailing Address - Country:US
Mailing Address - Phone:956-539-9631
Mailing Address - Fax:
Practice Address - Street 1:13668 ROOSEVELT AVE STE 5C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5510
Practice Address - Country:US
Practice Address - Phone:956-539-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY042926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist