Basic Information
| Provider Information | |||||||||
| NPI: | 1912404245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WERTZ | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | BRODEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1669 PHOENIX PKWY STE 102 | ||||||||
| Address2: | |||||||||
| City: | COLLEGE PARK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303495462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709071023 | ||||||||
| FaxNumber: | 7709075608 | ||||||||
| Practice Location | |||||||||
| Address1: | 1669 PHOENIX PKWY STE 102 | ||||||||
| Address2: | |||||||||
| City: | COLLEGE PARK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303495462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709071023 | ||||||||
| FaxNumber: | 7709075608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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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 | PT013203 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.