Provider Demographics
NPI:1447326996
Name:QUIMSON, MARIE LOUISE (PT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:QUIMSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TRIXIE
Other - Middle Name:
Other - Last Name:QUIMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1619
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-6619
Mailing Address - Country:US
Mailing Address - Phone:510-888-9300
Mailing Address - Fax:
Practice Address - Street 1:771 JACKSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1032
Practice Address - Country:US
Practice Address - Phone:510-888-9300
Practice Address - Fax:510-280-8802
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist