Provider Demographics
NPI:1861542052
Name:BAITZ, JAY N (PT)
Entity type:Individual
Prefix:MR
First Name:JAY
Middle Name:N
Last Name:BAITZ
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 1:9346 KIMMEL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1858
Mailing Address - Country:US
Mailing Address - Phone:704-995-7901
Mailing Address - Fax:
Practice Address - Street 1:9346 KIMMEL LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-1858
Practice Address - Country:US
Practice Address - Phone:704-399-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5243174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist