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General NPI Number Information
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NPI Number | 1679944672
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Entity Type | Individual
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Provider Name | ALEX WARNE ATC
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Gender | Male
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 4180 N ORION BLVD
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City | ORLANDO
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State | FL
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Zip | 32816-8029
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Country | US
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Telephone | 614-893-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 3870 GRANDPINE WAY APT 306
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City | CASSELBERRY
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State | FL
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Zip | 32707-4385
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Country | US
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Telephone | 614-893-7084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL4230
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License Number State | FL
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