Provider Demographics
NPI:1154471852
Name:WARLICK, BRYAN NELSON (MPT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:NELSON
Last Name:WARLICK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 NORTHBROOK BLVD STE A10
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9253
Mailing Address - Country:US
Mailing Address - Phone:843-797-5167
Mailing Address - Fax:843-797-5723
Practice Address - Street 1:2070 NORTHBROOK BLVD STE A10
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9253
Practice Address - Country:US
Practice Address - Phone:843-797-5167
Practice Address - Fax:843-797-5723
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5107225100000X
GAPT008378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP-3587Medicaid
SCGP-3587Medicaid