Provider Demographics
NPI:1366764912
Name:WARREN, MELANIE (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 MONTLIEU AVE
Mailing Address - Street 2:DEPT. OF ATHLETIC TRAINING
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4221
Mailing Address - Country:US
Mailing Address - Phone:336-841-4520
Mailing Address - Fax:336-841-9182
Practice Address - Street 1:833 MONTLIEU AVE
Practice Address - Street 2:DEPT. OF ATHLETIC TRAINING
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4221
Practice Address - Country:US
Practice Address - Phone:336-841-4520
Practice Address - Fax:336-841-9182
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer