Provider Demographics
NPI:1881942738
Name:WARBER, STEVEN R (PTA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:WARBER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 CHURCHILL STREET
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2027
Mailing Address - Country:US
Mailing Address - Phone:715-258-8131
Mailing Address - Fax:715-258-0179
Practice Address - Street 1:1401 CHURCHILL STREET
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2027
Practice Address - Country:US
Practice Address - Phone:715-258-8131
Practice Address - Fax:715-258-0179
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1932-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant