MEDICARE: ALEX WARNE ATC

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	2255A2300X	Athletic Trainer	AL4230	FL

General Provider Information

NPI Number	:	1679944672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX WARNE ATC

Provider Business Mailing Address
First Line	:	3870 GRANDPINE WAY APT 306
Second Line	:
City	:	CASSELBERRY
State	:	FL
Zip	:	32707-4385
Country	:	US
Telephone Number	:	614-893-7084
Fax Number	:

Provider Business Practice Location Address
First Line	:	4180 N ORION BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32816-8029
Country	:	US
Telephone Number	:	614-893-7084
Fax Number	:

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

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	05/02/2019

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