Provider Demographics
NPI:1659424208
Name:COMSTOCK, WARREN R Q (MPT)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:R Q
Last Name:COMSTOCK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23832 ROCKFIELD BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2820
Mailing Address - Country:US
Mailing Address - Phone:949-465-9500
Mailing Address - Fax:949-465-9506
Practice Address - Street 1:23832 ROCKFIELD BLVD STE 160
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2820
Practice Address - Country:US
Practice Address - Phone:949-465-9500
Practice Address - Fax:949-465-9506
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPT24606225100000X
CAPT24606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT24606OtherPT LICENSE