Provider Demographics
NPI:1508859034
Name:DEITZ, DAVID ALAN (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:DEITZ
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 HICKORY POINT RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:724-288-1639
Mailing Address - Fax:
Practice Address - Street 1:107 TRITON LN
Practice Address - Street 2:
Practice Address - City:SURF CITY
Practice Address - State:NC
Practice Address - Zip Code:28445-6923
Practice Address - Country:US
Practice Address - Phone:910-803-2040
Practice Address - Fax:910-803-2050
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPT14321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396687Medicare ID - Type Unspecified