Provider Demographics
NPI:1295813269
Name:FOLTZ, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FOLTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 SHEPHERDS POND
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7799
Mailing Address - Country:US
Mailing Address - Phone:770-667-8071
Mailing Address - Fax:
Practice Address - Street 1:540 LAKE CENTER PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-7727
Practice Address - Country:US
Practice Address - Phone:770-205-3939
Practice Address - Fax:770-205-4994
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT004805OtherLICENSE#