Provider Demographics
NPI:1851407233
Name:PUTZ, ERIC NATHAN (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:NATHAN
Last Name:PUTZ
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 1:250 CARLSON PKWY APT 323
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5321
Mailing Address - Country:US
Mailing Address - Phone:352-672-2477
Mailing Address - Fax:
Practice Address - Street 1:652 TRANSFER RD
Practice Address - Street 2:SUITE 16
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1427
Practice Address - Country:US
Practice Address - Phone:651-646-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist