Individual
EZRA WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13330 DETROIT AVE, LAKEWOOD, OH 44107-2850
(216) 228-9550
Mailing address
12971 HARLON AVE, LAKEWOOD, OH 44107-2811
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA012750
OH
Other
Enumeration date
02/16/2024
Last updated
02/16/2024
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