Provider Demographics
NPI:1679629786
Name:KURTZ, HENRY G (PT, MPH)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:G
Last Name:KURTZ
Suffix:
Gender:M
Credentials:PT, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S EL CAMINO REAL STE A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4150
Mailing Address - Country:US
Mailing Address - Phone:760-334-3440
Mailing Address - Fax:760-334-3441
Practice Address - Street 1:201 S EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4150
Practice Address - Country:US
Practice Address - Phone:760-334-3440
Practice Address - Fax:760-334-3441
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12156174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15001Medicare UPIN