Provider Demographics
NPI:1740393081
Name:WALTZ, DANIEL E (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:WALTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8131
Mailing Address - Country:US
Mailing Address - Phone:717-625-2491
Mailing Address - Fax:
Practice Address - Street 1:2821 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9213
Practice Address - Country:US
Practice Address - Phone:717-840-1874
Practice Address - Fax:717-840-0968
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007015L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088657TX9Medicare ID - Type Unspecified