Provider Demographics
NPI:1134136617
Name:WARREN, STACI MICHELLE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:MICHELLE
Last Name:WARREN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 BROWNSPOINT BLVD. NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422
Mailing Address - Country:US
Mailing Address - Phone:253-241-2470
Mailing Address - Fax:
Practice Address - Street 1:900 S 336TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6311
Practice Address - Country:US
Practice Address - Phone:253-942-3308
Practice Address - Fax:253-815-8805
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist