Provider Demographics
NPI:1740285451
Name:WARREN, MELANIE S (PT)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:S
Last Name:WARREN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E LAYFAIR DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7604
Mailing Address - Country:US
Mailing Address - Phone:601-420-6867
Mailing Address - Fax:601-664-1006
Practice Address - Street 1:201 E LAYFAIR DR
Practice Address - Street 2:SUITE 125
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7604
Practice Address - Country:US
Practice Address - Phone:601-420-6867
Practice Address - Fax:601-664-1006
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08935713Medicaid
MS650012643OtherMEDICARE RAILROAD
MS08935713Medicaid