Provider Demographics
NPI:1225442635
Name:ENTZ, JOANNA M (MS, LAT , ATC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:ENTZ
Suffix:
Gender:F
Credentials:MS, LAT , ATC
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:BALTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:502 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-1228
Mailing Address - Country:US
Mailing Address - Phone:610-207-8604
Mailing Address - Fax:
Practice Address - Street 1:3113 N WAGNER CIR
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-8938
Practice Address - Country:US
Practice Address - Phone:610-207-8604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
PART0059372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer