MEDICARE: MRS. ELIZABETH WANTZ PT, DPT, A.T.C.

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
1	2255A2300X	Athletic Trainer	RT003599	PA
2	225100000X	Physical Therapist	PT019991	PA

General Provider Information

NPI Number	:	1619936879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH WANTZ PT, DPT, A.T.C.

Provider Business Mailing Address
First Line	:	302 ROCKY CT W
Second Line	:
City	:	CHALFONT
State	:	PA
Zip	:	18914-2018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4259 W SWAMP RD STE 204
Second Line	:
City	:	DOYLESTOWN
State	:	PA
Zip	:	18902-1033
Country	:	US
Telephone Number	:	215-345-2202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	08/20/2021

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