Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1313667 | TX |
NPI | 1316591886 |
---|---|
Provider Name | John Walter Warner JR. |
First Address | Houston, TX 77084 |
Second Address | Houston, TX 77094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2019 |
Last Update Date | 01/08/2019 |