Healthcare Provider Details

I. General information

NPI: 1619936879
Provider Name (Legal Business Name): ELIZABETH WANTZ PT, DPT, A.T.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4259 W SWAMP RD STE 204
DOYLESTOWN PA
18902-1033
US

IV. Provider business mailing address

302 ROCKY CT W
CHALFONT PA
18914-2018
US

V. Phone/Fax

Practice location:
  • Phone: 215-345-2202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003599
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019991
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: