Provider Demographics
NPI:1417353624
Name:FRANTZ, DEREK JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:JAMES
Last Name:FRANTZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 RITCHIE HWY 500
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3099
Mailing Address - Country:US
Mailing Address - Phone:410-766-4047
Mailing Address - Fax:
Practice Address - Street 1:9815 MAIN STREET
Practice Address - Street 2:SUITE 206
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872
Practice Address - Country:US
Practice Address - Phone:301-253-6761
Practice Address - Fax:301-253-6762
Is Sole Proprietor?:No
Enumeration Date:2014-11-15
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist