Healthcare Provider Details

I. General information

NPI: 1154471852
Provider Name (Legal Business Name): BRYAN NELSON WARLICK MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 NORTHBROOK BLVD STE A10
NORTH CHARLESTON SC
29406-9253
US

IV. Provider business mailing address

2070 NORTHBROOK BLVD STE A10
NORTH CHARLESTON SC
29406-9253
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-5167
  • Fax: 843-797-5723
Mailing address:
  • Phone: 843-797-5167
  • Fax: 843-797-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5107
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008378
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: