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NPI Code Detail

MEDICARE: STACY WARREN DPT

MEDICARE: STACY 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
12251P0200XPediatric Physical TherapistPT 003420WV

General Provider Information

NPI Number : 1669879078
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY WARREN DPT
Provider Business Mailing Address
First Line : 5474 SHAWNEE CIR APT. 30
Second Line :
City : HUNTINGTON
State : WV
Zip : 25703-3377
Country : US
Telephone Number : 740-671-8458
Fax Number : 304-201-5123
Provider Business Practice Location Address
First Line : 179 STATION PL
Second Line : SUITE 100
City : HURRICANE
State : WV
Zip : 25526-6578
Country : US
Telephone Number : 304-760-6300
Fax Number : 304-201-5123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2014
Last Update Date : 12/01/2014

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