Provider Demographics
NPI:1467997304
Name:STOLTZ, REBECCA (LAT, ATC, MS)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:LAT, ATC, MS
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:832 TEMON ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-5604
Mailing Address - Country:US
Mailing Address - Phone:815-529-5042
Mailing Address - Fax:
Practice Address - Street 1:212 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2806
Practice Address - Country:US
Practice Address - Phone:815-529-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-2816246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other