Provider Demographics
NPI:1083484539
Name:WARNER, TIMOTHY ALLEN
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:WARNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35795 WOLF PEN RD
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:OH
Mailing Address - Zip Code:45769-9663
Mailing Address - Country:US
Mailing Address - Phone:213-905-8648
Mailing Address - Fax:
Practice Address - Street 1:5757 WILSHIRE BLVD STE 460
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3658
Practice Address - Country:US
Practice Address - Phone:323-634-0221
Practice Address - Fax:323-634-0227
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
CAPT306099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist