MEDICARE: DR. DETLEF JAMES MALTAS 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
1	2251S0007X	Sports Physical Therapist	004685	IA

General Provider Information

NPI Number	:	1841595535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DETLEF JAMES MALTAS DPT

Provider Business Mailing Address
First Line	:	6000 UNIVERSITY AVE STE 250
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8206
Country	:	US
Telephone Number	:	515-221-1102
Fax Number	:	515-221-1272

Provider Business Practice Location Address
First Line	:	6000 UNIVERSITY AVE STE 250
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8206
Country	:	US
Telephone Number	:	515-221-1102
Fax Number	:	515-221-1272

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

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	01/11/2011

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