Active NPI
Jennifer Waltz, PTA
- Physical Therapy Assistant
- Scarborough, ME
National Provider Identifier
1972736635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PA3568
- Practice address
- 67 Pine Point Rd
Scarborough, ME 04074-8813 - Phone
- (207) 883-2468
- Fax
- (207) 883-3283
- NPI assigned
- Aug 28, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PA3568 | ME | Primary |
Addresses
Primary practice location
67 Pine Point Rd
Scarborough, ME 04074-8813
Mailing address
210 Beach St
Apt #16
Saco, ME 04072-2953
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA3568 | ME | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251417600000",
"number": "1972736635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 BEACH ST",
"address_2": "APT #16",
"city": "SACO",
"state": "ME",
"postal_code": "040722953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 PINE POINT RD",
"city": "SCARBOROUGH",
"state": "ME",
"postal_code": "040748813",
"telephone_number": "207-883-2468",
"fax_number": "207-883-3283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTZ",
"first_name": "JENNIFER",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-28",
"last_updated": "2009-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ME",
"license": "PA3568",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Scarborough, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.