Provider Demographics
NPI:1073926135
Name:STULTZ, REHANNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:REHANNA
Middle Name:
Last Name:STULTZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12411 HYMEADOW DR STE 3B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1829
Mailing Address - Country:US
Mailing Address - Phone:512-335-9300
Mailing Address - Fax:512-335-9301
Practice Address - Street 1:12411 HYMEADOW DR STE 3B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1829
Practice Address - Country:US
Practice Address - Phone:512-335-9300
Practice Address - Fax:512-335-9301
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1367046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist