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NPI Code Detail

MEDICARE: ELLEN WARNOCK DPT

MEDICARE: ELLEN WARNOCK 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
1225100000XPhysical Therapist12877TN

General Provider Information

NPI Number : 1134745235
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN WARNOCK DPT
Provider Business Mailing Address
First Line : 1352 HARBOR PARK DR
Second Line :
City : MEMPHIS
State : TN
Zip : 38103-9031
Country : US
Telephone Number : 901-282-9393
Fax Number :
Provider Business Practice Location Address
First Line : 1314 PEABODY AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-3500
Country : US
Telephone Number : 901-321-5803
Fax Number : 901-405-0250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2020
Last Update Date : 12/19/2023

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