Provider Demographics
NPI:1124222377
Name:SCHULTZ, PENNY L (LMT)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27104 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3253
Mailing Address - Country:US
Mailing Address - Phone:440-342-0489
Mailing Address - Fax:
Practice Address - Street 1:6325 YORK RD
Practice Address - Street 2:SUITE #101
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3030
Practice Address - Country:US
Practice Address - Phone:440-342-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.014136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist