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NPI Code Detail

MEDICARE: RYAN LEE WARREN PT

MEDICARE: RYAN LEE 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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1326538471
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN LEE WARREN PT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2222
Fax Number :
Provider Business Practice Location Address
First Line : 3218 DAUGHERTY DR STE 160
Second Line :
City : LAFAYETTE
State : IN
Zip : 47909-4402
Country : US
Telephone Number : 765-477-6464
Fax Number : 765-477-6262
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2018
Last Update Date : 05/15/2018

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Directions to “ RYAN LEE WARREN PT” Practice Location

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