Healthcare Provider Details

I. General information

NPI: 1104362243
Provider Name (Legal Business Name): ANNA MARIA WARMUZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BELLE TERRE RD C/O ST. CHARLES HOSPITAL PED. PT
PORT JEFFERSON NY
11777-1928
US

IV. Provider business mailing address

12 VALLEY CT
HOLTSVILLE NY
11742-1065
US

V. Phone/Fax

Practice location:
  • Phone: 201-394-9514
  • Fax:
Mailing address:
  • Phone: 201-394-9514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number041079
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: