Provider Demographics
NPI:1023063948
Name:STOLTZ, SUSAN JANE (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:STOLTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3629
Mailing Address - Country:US
Mailing Address - Phone:317-356-7800
Mailing Address - Fax:317-356-4586
Practice Address - Street 1:1048 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3629
Practice Address - Country:US
Practice Address - Phone:317-356-7800
Practice Address - Fax:317-356-4586
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007021A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist