Provider Demographics
NPI:1366038010
Name:WARICK, ELLE SUZANNE (DPT)
Entity Type:Individual
Prefix:
First Name:ELLE
Middle Name:SUZANNE
Last Name:WARICK
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 1:2413 MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946-3979
Mailing Address - Country:US
Mailing Address - Phone:518-420-9865
Mailing Address - Fax:
Practice Address - Street 1:185 OLD MILITARY RD
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946-1939
Practice Address - Country:US
Practice Address - Phone:518-523-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist