Provider Demographics
NPI:1093790347
Name:SCHULTZ, SCOTT J (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:SCHULTZ
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 1:4151 W ORLEANS ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3973
Mailing Address - Country:US
Mailing Address - Phone:815-344-9727
Mailing Address - Fax:815-344-9728
Practice Address - Street 1:4151 W ORLEANS ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3973
Practice Address - Country:US
Practice Address - Phone:815-344-9727
Practice Address - Fax:815-344-9728
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14762Medicare ID - Type UnspecifiedPERSONAL MC ID