Provider Demographics
NPI:1730747379
Name:ANDERSON, QUINTEZ DWAYNE (DPT)
Entity type:Individual
Prefix:
First Name:QUINTEZ
Middle Name:DWAYNE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 W WARM SPRINGS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-3646
Mailing Address - Country:US
Mailing Address - Phone:702-227-2152
Mailing Address - Fax:702-252-0369
Practice Address - Street 1:8751 W CHARLESTON BLVD STE 270
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5497
Practice Address - Country:US
Practice Address - Phone:702-982-2232
Practice Address - Fax:702-982-2237
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist