Provider Demographics
NPI:1881143121
Name:MALTSBERGER, DANE L (CRT, RRT)
Entity type:Individual
Prefix:
First Name:DANE
Middle Name:L
Last Name:MALTSBERGER
Suffix:
Gender:M
Credentials:CRT, RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:VEEDERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47987-0122
Mailing Address - Country:US
Mailing Address - Phone:765-585-0188
Mailing Address - Fax:
Practice Address - Street 1:2009 S 100 W
Practice Address - Street 2:
Practice Address - City:VEEDERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47987-8150
Practice Address - Country:US
Practice Address - Phone:765-585-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN30008751A227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN30008751AOtherRESPIRATORY CARE PRACTITIONER LIC