Provider Demographics
NPI:1245775014
Name:WARREN, LUIZE (DPT)
Entity Type:Individual
Prefix:
First Name:LUIZE
Middle Name:
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 1:2300 JENKS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5469
Mailing Address - Country:US
Mailing Address - Phone:850-249-1603
Mailing Address - Fax:850-249-1605
Practice Address - Street 1:2300 JENKS AVE STE C
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5469
Practice Address - Country:US
Practice Address - Phone:850-249-1603
Practice Address - Fax:850-249-1605
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTT32245261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy