Provider Demographics
NPI:1518956549
Name:WALTZ, ROSS ELWOOD (MSPT)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:ELWOOD
Last Name:WALTZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:850 MILL ST
Mailing Address - Street 2:#300
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1413
Mailing Address - Country:US
Mailing Address - Phone:775-337-8776
Mailing Address - Fax:775-337-8778
Practice Address - Street 1:850 MILL ST
Practice Address - Street 2:#300
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1413
Practice Address - Country:US
Practice Address - Phone:775-337-8776
Practice Address - Fax:775-337-8778
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVS94918Medicare UPIN
NVV36704Medicare PIN