Healthcare Provider Details

I. General information

NPI: 1487696829
Provider Name (Legal Business Name): WARREN CLARK HERSEY III MS, PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

10853 43RD ST N UNIT 1201
CLEARWATER FL
33762-5248
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax: 813-978-5852
Mailing address:
  • Phone: 727-571-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT15443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: