Provider Demographics
NPI:1942577929
Name:VERTZ, CHARLES COLE VICTOR (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:COLE VICTOR
Last Name:VERTZ
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 SUMMIT PLACE DR NW
Mailing Address - Street 2:#708
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8171
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704-A COLLEGE ST
Practice Address - Street 2:BARTON COLLEGE
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893
Practice Address - Country:US
Practice Address - Phone:252-399-6534
Practice Address - Fax:252-399-6516
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200167422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer