Provider Demographics
NPI:1992555924
Name:FOLTZ, BRYAN JAMES
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:FOLTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20553 KISER RD
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-9060
Mailing Address - Country:US
Mailing Address - Phone:419-980-6813
Mailing Address - Fax:
Practice Address - Street 1:20553 KISER RD
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-9060
Practice Address - Country:US
Practice Address - Phone:419-980-6813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRS559528172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver