MEDICARE: EMILY WARREN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	10496988-2401	UT

General Provider Information

NPI Number	:	1093253122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY WARREN DPT

Provider Business Mailing Address
First Line	:	1892 S 1000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3337
Country	:	US
Telephone Number	:	385-332-4939
Fax Number	:

Provider Business Practice Location Address
First Line	:	1892 S 1000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-3337
Country	:	US
Telephone Number	:	385-332-4939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	07/11/2022

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