Provider Demographics
NPI:1770958050
Name:PELTZ, STANLEY (PTA)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:PELTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 DARNABY WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5074
Mailing Address - Country:US
Mailing Address - Phone:407-394-6078
Mailing Address - Fax:
Practice Address - Street 1:1103 N THORNTON AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:321-430-0551
Practice Address - Fax:407-641-9707
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26201225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686675Medicare Oscar/Certification