Provider Demographics
NPI:1053634519
Name:DILTZ, DANNY LEE (PTA)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:LEE
Last Name:DILTZ
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 1:2302 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2771
Mailing Address - Country:US
Mailing Address - Phone:330-696-9325
Mailing Address - Fax:
Practice Address - Street 1:2302 NORMAN DR
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2771
Practice Address - Country:US
Practice Address - Phone:330-696-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA5564225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant