Provider Demographics
NPI:1841329588
Name:KOLTZ, BERNADETTE JEAN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:JEAN
Last Name:KOLTZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 NEWELL LN
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-4074
Mailing Address - Country:US
Mailing Address - Phone:330-313-1312
Mailing Address - Fax:
Practice Address - Street 1:3800 PARK EAST DR
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4316
Practice Address - Country:US
Practice Address - Phone:216-831-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist