Provider Demographics
NPI:1124380027
Name:HOLTZ, MAUREEN ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:HOLTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 COOK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-9340
Mailing Address - Country:US
Mailing Address - Phone:816-261-2967
Mailing Address - Fax:
Practice Address - Street 1:1802 N WOODBINE RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3667
Practice Address - Country:US
Practice Address - Phone:816-232-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012015558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist