Provider Demographics
NPI:1073949830
Name:BALTOSSER, DAVID A (RRT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:BALTOSSER
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 N MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-8303
Mailing Address - Country:US
Mailing Address - Phone:574-514-8283
Mailing Address - Fax:
Practice Address - Street 1:2306 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3213
Practice Address - Country:US
Practice Address - Phone:574-514-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN30005101A2279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health