Provider Demographics
NPI:1215192349
Name:WARNER, DANETTE LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:LEE
Last Name:WARNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W. LAKE LANSING RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-333-8533
Mailing Address - Fax:517-333-8539
Practice Address - Street 1:830 W. LAKE LANSING RD
Practice Address - Street 2:SUITE 190
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-333-8533
Practice Address - Fax:517-333-8539
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
30658OtherBLUE CROSS
236520Medicare Oscar/Certification