Provider Demographics
NPI:1811400088
Name:WARE, CHANNING (DPT)
Entity Type:Individual
Prefix:
First Name:CHANNING
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHANNING
Other - Middle Name:
Other - Last Name:FLEISCHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:555 N ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4723
Mailing Address - Country:US
Mailing Address - Phone:775-786-3040
Mailing Address - Fax:775-786-1887
Practice Address - Street 1:555 N ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4723
Practice Address - Country:US
Practice Address - Phone:775-786-3040
Practice Address - Fax:775-786-6942
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14672145OtherCAQH
NV1811400088Medicaid