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NPI Code Detail

MEDICARE: LISA BRACK WARREN PT

MEDICARE: LISA BRACK WARREN PT
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
12251P0200XPediatric Physical Therapist2268NM

General Provider Information

NPI Number : 1245445329
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA BRACK WARREN PT
Provider Business Mailing Address
First Line : 7208 MACKENZIE CT NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-8467
Country : US
Telephone Number : 505-867-5825
Fax Number :
Provider Business Practice Location Address
First Line : 10101 W PALMERAS DR
Second Line :
City : SUN CITY
State : AZ
Zip : 85373-2046
Country : US
Telephone Number : 877-407-3422
Fax Number : 877-407-4329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 04/15/2025

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