Provider Demographics
NPI:1841595535
Name:MALTAS, DETLEF JAMES (DPT)
Entity Type:Individual
Prefix:DR
First Name:DETLEF
Middle Name:JAMES
Last Name:MALTAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 UNIVERSITY AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8206
Mailing Address - Country:US
Mailing Address - Phone:515-221-1102
Mailing Address - Fax:515-221-1272
Practice Address - Street 1:6000 UNIVERSITY AVE STE 250
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8206
Practice Address - Country:US
Practice Address - Phone:515-221-1102
Practice Address - Fax:515-221-1272
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0046852251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
I17812Medicare UPIN