Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1281020 | TX |
NPI | 1336769298 |
---|---|
Provider Name | Dr. Craig Michael Warner |
First Address | Haslet, TX 76052-1375 |
Second Address | Fort Worth, TX 76104-7301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2020 |
Last Update Date | 21/04/2020 |