Provider Demographics
NPI:1346734308
Name:ERIC WALZ, PHYSICAL THERAPIST, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ERIC WALZ, PHYSICAL THERAPIST, A PROFESSIONAL CORPORATION
Other - Org Name:ADVANCED PHYSICAL THERAPISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WALZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:818-823-6621
Mailing Address - Street 1:303 N GLENOAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1118
Mailing Address - Country:US
Mailing Address - Phone:818-823-6621
Mailing Address - Fax:818-483-2369
Practice Address - Street 1:303 N GLENOAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1118
Practice Address - Country:US
Practice Address - Phone:818-823-6621
Practice Address - Fax:818-356-4380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty