Healthcare Provider Details

I. General information

NPI: 1710001268
Provider Name (Legal Business Name): KEITH WARWICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SOUTH RAYMOND AVE SUITE 120
PASADENA CA
91105
US

IV. Provider business mailing address

3283 MOTOR AVE SUITE 120
LOS ANGELES CA
90034-3709
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-1444
  • Fax: 626-403-1448
Mailing address:
  • Phone: 310-845-9690
  • Fax: 310-845-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: