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NPI Code Detail

MEDICARE: BLAIRE ASHLEY WALTZ DPT

MEDICARE: BLAIRE ASHLEY WALTZ DPT
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
1225100000XPhysical TherapistP21358NC
2225100000XPhysical Therapist12466SC

General Provider Information

NPI Number : 1477282390
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAIRE ASHLEY WALTZ DPT
Provider Business Mailing Address
First Line : 1991 FORDHAM DR STE 102
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3774
Country : US
Telephone Number : 910-484-4653
Fax Number : 910-483-9256
Provider Business Practice Location Address
First Line : 1991 FORDHAM DR STE 102
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3774
Country : US
Telephone Number : 910-484-4653
Fax Number : 910-483-9256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2022
Last Update Date : 01/14/2026

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Practice Location Address:
1991 FORDHAM DR STE 102
FAYETTEVILLE, NC
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1508715616 — CRISTINA MARTINEZ LOPEZ OTR/L
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1467266932 — DESTINI ARIANA FERRARO PT, DPT
Practice Location Address:
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FAYETTEVILLE, NC
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1407719735 — RYAN DAVID PARKER
Practice Location Address:
1991 FORDHAM DR STE 102
FAYETTEVILLE, NC
28304-3774
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1184581415 — NICHOLAS COLE KUHNEL
Practice Location Address:
1991 FORDHAM DR STE 102
FAYETTEVILLE, NC
28304-3774
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Practice Fax: 910-483-9256

Directions to “ BLAIRE ASHLEY WALTZ DPT” Practice Location

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