Provider Demographics
NPI:1235582891
Name:WARREN, STEPHEN (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:WARREN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14323 OCEAN HWY STE 4142
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-4817
Mailing Address - Country:US
Mailing Address - Phone:843-455-4228
Mailing Address - Fax:
Practice Address - Street 1:14323 OCEAN HWY STE 4142
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4817
Practice Address - Country:US
Practice Address - Phone:843-455-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1881225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist