MEDICARE: EMILY DEAN WARREN PT

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	4884	OR

General Provider Information

NPI Number	:	1356403521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY DEAN WARREN PT

Provider Business Mailing Address
First Line	:	242 FERN VALLEY RD
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535-9104
Country	:	US
Telephone Number	:	541-512-0757
Fax Number	:	541-535-6016

Provider Business Practice Location Address
First Line	:	242 FERN VALLEY RD
Second Line	:
City	:	PHOENIX
State	:	OR
Zip	:	97535-9104
Country	:	US
Telephone Number	:	541-512-0757
Fax Number	:	541-535-6016

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	04/27/2016

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Directions to “ EMILY DEAN WARREN PT” Practice Location

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