Provider Demographics
NPI:1437373651
Name:WARMOUTH, DANA (MPT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:WARMOUTH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 BALES DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-8582
Mailing Address - Country:US
Mailing Address - Phone:217-276-2500
Mailing Address - Fax:888-972-8901
Practice Address - Street 1:6321 BALES DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-8582
Practice Address - Country:US
Practice Address - Phone:217-276-2500
Practice Address - Fax:888-972-8901
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-010812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1532007OtherBCBS PPO #