Provider Demographics
NPI:1750032249
Name:WARNKE, HAYLEE (PTA)
Entity Type:Individual
Prefix:
First Name:HAYLEE
Middle Name:
Last Name:WARNKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 HIGHLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6730
Mailing Address - Country:US
Mailing Address - Phone:618-977-7987
Mailing Address - Fax:
Practice Address - Street 1:100 ROSEWOOD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2301
Practice Address - Country:US
Practice Address - Phone:618-236-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160008038225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty