Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1239 | WY |
NPI | 1003053331 |
---|---|
Provider Name | Haley Kathleen Baltz |
First Address | Sheridan, WY 82801-3606 |
Second Address | Sheridan, WY 82801-3606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2009 |
Last Update Date | 08/01/2009 |