Provider Demographics
NPI:1780132159
Name:WALZ, ERIC (DPT)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:WALZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N GLENOAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1118
Mailing Address - Country:US
Mailing Address - Phone:818-823-6621
Mailing Address - Fax:818-483-2369
Practice Address - Street 1:303 N GLENOAKS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502
Practice Address - Country:US
Practice Address - Phone:818-823-6621
Practice Address - Fax:818-356-4380
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist