Provider Demographics
NPI:1730660838
Name:NETZ, DEJA CRYSTAL (DPT)
Entity Type:Individual
Prefix:
First Name:DEJA
Middle Name:CRYSTAL
Last Name:NETZ
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 1:1334 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5067
Mailing Address - Country:US
Mailing Address - Phone:505-292-3317
Mailing Address - Fax:505-292-3402
Practice Address - Street 1:1334 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5067
Practice Address - Country:US
Practice Address - Phone:505-292-3317
Practice Address - Fax:505-292-3402
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist