Provider Demographics
NPI:1568772150
Name:WARNER, NICOLE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:WARNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:37650 PROFESSIONAL CENTER DRIVE
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1199
Mailing Address - Country:US
Mailing Address - Phone:734-953-1745
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:37650 PROFESSIONAL CENTER DRIVE
Practice Address - Street 2:SUITE 105A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1199
Practice Address - Country:US
Practice Address - Phone:734-953-1745
Practice Address - Fax:734-953-1743
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist