Provider Demographics
NPI:1194760355
Name:BALTZ, KEVIN CHRISTOPHER (PT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:BALTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MAPLE AVE
Mailing Address - Street 2:SUITE 505
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764
Mailing Address - Country:US
Mailing Address - Phone:479-872-1305
Mailing Address - Fax:479-872-2437
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764
Practice Address - Country:US
Practice Address - Phone:479-872-1305
Practice Address - Fax:479-872-2437
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPT2776OtherARK STATE BOARD OF PHYSIC
AR5Y078OtherBLUE CROSS BLUE SHIELD