Provider Demographics
NPI:1497164453
Name:WARBRITTON, CLARA LILIAN (DPT)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:LILIAN
Last Name:WARBRITTON
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:PO BOX 21563
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97307-1563
Mailing Address - Country:US
Mailing Address - Phone:503-390-9009
Mailing Address - Fax:503-393-0834
Practice Address - Street 1:210 W ELLENDALE AVE
Practice Address - Street 2:STE 100
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1790
Practice Address - Country:US
Practice Address - Phone:503-623-2433
Practice Address - Fax:503-623-2196
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist