Provider Demographics
NPI:1588151559
Name:WARNER, JILLIAN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1304
Mailing Address - Country:US
Mailing Address - Phone:610-237-1714
Mailing Address - Fax:
Practice Address - Street 1:779 W SPROUL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1215
Practice Address - Country:US
Practice Address - Phone:484-470-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0053732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer