Provider Demographics
NPI:1730464850
Name:PROTZ, MARY BETH (DPT)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:PROTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E OLYMPIA AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3838
Mailing Address - Country:US
Mailing Address - Phone:941-575-7300
Mailing Address - Fax:941-505-7301
Practice Address - Street 1:530 E OLYMPIA AVE
Practice Address - Street 2:STE 112
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3838
Practice Address - Country:US
Practice Address - Phone:941-575-7300
Practice Address - Fax:941-505-7301
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist