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General NPI Number Information
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NPI Number | 1679095954
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Entity Type | Individual
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Provider Name | DAVID JANTZ LAT, ATC, PES, CES
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Gender | Male
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Dates
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Enumeration Date | 07/08/2017
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Last Update Date | 07/08/2017
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Provider Practice Location Address
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Address Line | 13895 HWY 27
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City | LAKE WALES
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State | FL
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Zip | 33859-2549
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Country | US
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Telephone | 863-368-7567
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Fax |
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Provider Business Mailing Address
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Address Line | 13895 HIGHWAY 27
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City | LAKE WALES
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State | FL
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Zip | 33859
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | AL3484
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License Number State | FL
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