Provider Demographics
NPI:1083885289
Name:WARREN, STEVEN R
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:WARREN
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 1:901 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1123
Mailing Address - Country:US
Mailing Address - Phone:270-384-4753
Mailing Address - Fax:270-385-9123
Practice Address - Street 1:901 WESTLAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1123
Practice Address - Country:US
Practice Address - Phone:270-384-4753
Practice Address - Fax:270-385-9123
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY004174OtherLICENSE