Provider Demographics
NPI:1477595999
Name:BOLTZ SPANGLER, EILEEN (DPT)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:BOLTZ SPANGLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:213 GREENHILL AVE
Practice Address - Street 2:STE C
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1844
Practice Address - Country:US
Practice Address - Phone:302-658-7800
Practice Address - Fax:302-658-1550
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1730452OtherPABS
DE1000037584Medicaid
DE10000037584Medicaid
1477595999OtherCHAMPUS TRICARE
64249301OtherNCA
PA2398179000OtherAMERIHEALTH PROVIDER ID
5070-0025OtherCARE FIRST
2398179000OtherAMERIHEALTH IBC
DE1000037584Medicaid
DE10000037584Medicaid