MEDICARE: CORANISHA LUELLA WARREN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11356	LA

General Provider Information

NPI Number	:	1215671359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORANISHA LUELLA WARREN PT, DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 LINDBERG DR STE 3400
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-8161
Country	:	US
Telephone Number	:	985-641-2996
Fax Number	:	985-601-2743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2022
Last Update Date	:	08/23/2022

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