Provider Demographics
NPI:1063840403
Name:SCHULTZ, MOLLY REESE (PT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:REESE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:REESE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3707 GRAND WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2754
Mailing Address - Country:US
Mailing Address - Phone:952-905-6059
Mailing Address - Fax:
Practice Address - Street 1:1747 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1128
Practice Address - Country:US
Practice Address - Phone:651-326-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-22
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8636261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy