Provider Demographics
NPI:1811434780
Name:WALTZ, PEYTON
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:WALTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 AUTUMN BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3854
Mailing Address - Country:US
Mailing Address - Phone:814-860-6564
Mailing Address - Fax:
Practice Address - Street 1:199 AUTUMN BREEZE WAY
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3854
Practice Address - Country:US
Practice Address - Phone:814-860-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician