Provider Demographics
NPI:1760455166
Name:WOLTZ PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:WOLTZ PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:319-352-0102
Mailing Address - Street 1:413 W BREMER AVE
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-3145
Mailing Address - Country:US
Mailing Address - Phone:319-352-0102
Mailing Address - Fax:319-352-0104
Practice Address - Street 1:413 W BREMER AVE
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-3145
Practice Address - Country:US
Practice Address - Phone:319-352-0102
Practice Address - Fax:319-352-0104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty