Provider Demographics
NPI:1336291228
Name:AJA, WARREN DALE (PT)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:DALE
Last Name:AJA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 W MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01337-9460
Mailing Address - Country:US
Mailing Address - Phone:413-648-0237
Mailing Address - Fax:
Practice Address - Street 1:95 LAUREL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3106
Practice Address - Country:US
Practice Address - Phone:413-774-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist