Provider Demographics
NPI:1134745235
Name:WARNOCK, ELLEN (DPT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:WARNOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 HARBOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-9031
Mailing Address - Country:US
Mailing Address - Phone:901-282-9393
Mailing Address - Fax:
Practice Address - Street 1:1314 PEABODY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3500
Practice Address - Country:US
Practice Address - Phone:901-321-5803
Practice Address - Fax:901-405-0250
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist