Individual
ROBERTA BOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1909 VISTA DR, LARAMIE, WY 82070
(307) 745-8851
(307) 742-0961
Mailing address
1909 VISTA DR, LARAMIE, WY 82070
(307) 745-8851
(307) 742-0961
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT199
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104232700
—
WY
01
—
310762
BCBS
—
01
—
650024124
RAILROAD MEDICARE
WY
Enumeration date
01/18/2006
Last updated
06/11/2009
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