Provider Demographics
NPI:1073524716
Name:BELTZ, RAYMOND JR (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:BELTZ
Suffix:JR
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 TOKA CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5419
Mailing Address - Country:US
Mailing Address - Phone:704-562-5405
Mailing Address - Fax:
Practice Address - Street 1:200 BAKER DR
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28035-7158
Practice Address - Country:US
Practice Address - Phone:704-894-2829
Practice Address - Fax:704-894-2802
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer