Provider Demographics
NPI:1255434882
Name:WARREN, EARL L III (PT)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:L
Last Name:WARREN
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:INNOVATIVE REHAB CARE
Mailing Address - Street 2:2286-1 WEDNESDAY ST
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-219-7826
Mailing Address - Fax:850-385-1322
Practice Address - Street 1:INNOVATIVE REHAB CARE
Practice Address - Street 2:2286-1 WEDNESDAY ST
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-219-7826
Practice Address - Fax:850-385-1322
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 8426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX 1452Medicare ID - Type Unspecified