Provider Demographics
NPI:1568611986
Name:WARNER, KELLEY (DPT)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:WARNER
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 1:6024 PUMA CHASE
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9422
Mailing Address - Country:US
Mailing Address - Phone:303-323-9998
Mailing Address - Fax:
Practice Address - Street 1:6024 PUMA CHASE
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-9422
Practice Address - Country:US
Practice Address - Phone:303-323-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205888225100000X
MD22875225100000X
CA338492251X0800X
COPTL0015961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic