Provider Demographics
NPI:1912404245
Name:WERTZ, ERIC BRODEY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRODEY
Last Name:WERTZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 WEDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8769
Mailing Address - Country:US
Mailing Address - Phone:678-928-5895
Mailing Address - Fax:
Practice Address - Street 1:6319 WEDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8769
Practice Address - Country:US
Practice Address - Phone:678-928-5895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist