Provider Demographics
NPI:1730130618
Name:WARREN, PAMELA MARIE (MS LAT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MARIE
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 W KNOX ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401
Mailing Address - Country:US
Mailing Address - Phone:715-843-6692
Mailing Address - Fax:
Practice Address - Street 1:16 E MENARD PLAZA
Practice Address - Street 2:SPORT & SPINE CLINIC
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54402
Practice Address - Country:US
Practice Address - Phone:715-845-2942
Practice Address - Fax:715-842-3416
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1870392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer