Provider Demographics
NPI:1477595999
Name:BOLTZ SPANGLER, EILEEN (DPT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BOLTZ SPANGLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:213 GREENHILL AVE
Practice Address - Street 2:STE C
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1844
Practice Address - Country:US
Practice Address - Phone:302-658-7800
Practice Address - Fax:302-658-1550
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5070-0025OtherCARE FIRST
DE10000037584Medicaid
DE1000037584Medicaid
PA2398179000OtherAMERIHEALTH PROVIDER ID
1477595999OtherCHAMPUS TRICARE
1730452OtherPABS
2398179000OtherAMERIHEALTH IBC
64249301OtherNCA
DE1000037584Medicaid
DE10000037584Medicaid