Provider Demographics
NPI:1699529750
Name:WARNER, KIMBERLY JAY (LPTA)
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:JAY
Last Name:WARNER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17811 21 1/2 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9344
Mailing Address - Country:US
Mailing Address - Phone:313-570-2029
Mailing Address - Fax:
Practice Address - Street 1:17811 21 1/2 MILE RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-9344
Practice Address - Country:US
Practice Address - Phone:313-570-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502003905225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant