Provider Demographics
NPI:1518700681
Name:WARREN, KELLY M
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 TAMIAMI TRL S STE 207
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2424
Mailing Address - Country:US
Mailing Address - Phone:941-445-0764
Mailing Address - Fax:
Practice Address - Street 1:333 TAMIAMI TRL S STE 207
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2424
Practice Address - Country:US
Practice Address - Phone:941-484-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant