Provider Demographics
NPI:1326415969
Name:WARREN, WANDA L (PT, LAC,MHS,DIPLAC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:WARREN
Suffix:
Gender:F
Credentials:PT, LAC,MHS,DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6407 BRAYTON DR STE 203A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2149
Mailing Address - Country:US
Mailing Address - Phone:907-202-9804
Mailing Address - Fax:888-957-1346
Practice Address - Street 1:6407 BRAYTON DR STE 203A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2149
Practice Address - Country:US
Practice Address - Phone:907-202-9804
Practice Address - Fax:888-957-1346
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK88171100000X
AK1612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist