Provider Demographics
NPI:1770785719
Name:STOLTZFUS, JAY E (PT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:STOLTZFUS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 EDELWEISS
Mailing Address - Street 2:
Mailing Address - City:TIJERAS
Mailing Address - State:NM
Mailing Address - Zip Code:87059-8055
Mailing Address - Country:US
Mailing Address - Phone:505-281-5431
Mailing Address - Fax:505-286-1662
Practice Address - Street 1:108 EDELWEISS
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-8055
Practice Address - Country:US
Practice Address - Phone:505-281-5431
Practice Address - Fax:505-286-1662
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist