Provider Demographics
NPI:1003295965
Name:SCHULTZ, LURESSA
Entity Type:Individual
Prefix:
First Name:LURESSA
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 ANDERMATT DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6032
Mailing Address - Country:US
Mailing Address - Phone:605-440-0728
Mailing Address - Fax:
Practice Address - Street 1:12151 AVENUE OF THE CHIEFS
Practice Address - Street 2:
Practice Address - City:CRAZY HORSE
Practice Address - State:SD
Practice Address - Zip Code:57730-8900
Practice Address - Country:US
Practice Address - Phone:605-440-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1259000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist