Provider Demographics
NPI:1821459025
Name:WARNER, SCOTT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:WARNER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 W ERDA WAY
Mailing Address - Street 2:
Mailing Address - City:ERDA
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9526
Mailing Address - Country:US
Mailing Address - Phone:801-897-7729
Mailing Address - Fax:
Practice Address - Street 1:1438 W ERDA WAY
Practice Address - Street 2:
Practice Address - City:ERDA
Practice Address - State:UT
Practice Address - Zip Code:84074-9526
Practice Address - Country:US
Practice Address - Phone:801-897-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT96003782401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist