Provider Demographics
NPI:1376000893
Name:PELTZ, JASON RICHARD (PTA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RICHARD
Last Name:PELTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31780 SIHAM RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-2028
Mailing Address - Country:US
Mailing Address - Phone:302-864-4324
Mailing Address - Fax:
Practice Address - Street 1:301 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1269
Practice Address - Country:US
Practice Address - Phone:302-645-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0001185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant