Provider Demographics
NPI:1871823997
Name:BALTHAZOR, ASPEN JOY (DPT)
Entity Type:Individual
Prefix:
First Name:ASPEN
Middle Name:JOY
Last Name:BALTHAZOR
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 1:731 KLEIN CIR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-7011
Mailing Address - Country:US
Mailing Address - Phone:316-719-2400
Mailing Address - Fax:
Practice Address - Street 1:731 KLEIN CIR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-7011
Practice Address - Country:US
Practice Address - Phone:316-719-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist