Provider Demographics
NPI:1952689051
Name:STELTZ, NATHAN MARK (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:MARK
Last Name:STELTZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 SOUTHWICK CIR
Mailing Address - Street 2:
Mailing Address - City:SOMERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:08083-2312
Mailing Address - Country:US
Mailing Address - Phone:610-763-0316
Mailing Address - Fax:
Practice Address - Street 1:200 TUCKERTON RD
Practice Address - Street 2:SUITE 17
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8806
Practice Address - Country:US
Practice Address - Phone:610-763-0316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01409500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist