Basic Information
| Provider Information | |||||||||
| NPI: | 1417353624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRANTZ | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7310 RITCHIE HWY 500 | ||||||||
| Address2: | |||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210613099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107664047 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9815 MAIN STREET | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | DAMASCUS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012536761 | ||||||||
| FaxNumber: | 3012536762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2014 | ||||||||
| LastUpdateDate: | 09/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 25284 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.