Provider Demographics
NPI:1124419130
Name:SCHULTES, GRANT
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:SCHULTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-1102
Mailing Address - Country:US
Mailing Address - Phone:712-642-2179
Mailing Address - Fax:712-642-3510
Practice Address - Street 1:631 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1102
Practice Address - Country:US
Practice Address - Phone:712-642-2179
Practice Address - Fax:712-642-3510
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist