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NPI Code Detail

MEDICARE: MR. JOSEPH DAVID WANTZ

MEDICARE: MR. JOSEPH DAVID WANTZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA5298MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134747207
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH DAVID WANTZ
Provider Business Mailing Address
First Line : 408 CORNICHE CT
Second Line :
City : WESTMINSTER
State : MD
Zip : 21158-4449
Country : US
Telephone Number : 410-207-4209
Fax Number :
Provider Business Practice Location Address
First Line : 6500 RIGGS RD
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20783-3056
Country : US
Telephone Number : 301-559-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2020
Last Update Date : 07/06/2020

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