Provider Demographics
NPI:1235150392
Name:WARNER PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:WARNER PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-326-0056
Mailing Address - Street 1:364 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6148
Mailing Address - Country:US
Mailing Address - Phone:315-326-0056
Mailing Address - Fax:315-326-0102
Practice Address - Street 1:364 EAST AVE
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-6148
Practice Address - Country:US
Practice Address - Phone:315-326-0056
Practice Address - Fax:315-326-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02622993Medicaid
NY02398341Medicaid
NYP17014Medicare UPIN