Provider Demographics
NPI:1184647943
Name:SHULTZ, SANDRA JANINE (PHD, ATC, CSCS)
Entity Type:Individual
Prefix:PROF
First Name:SANDRA
Middle Name:JANINE
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:PHD, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 COTSWOLD TER
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2012
Mailing Address - Country:US
Mailing Address - Phone:336-540-0545
Mailing Address - Fax:335-334-3238
Practice Address - Street 1:UNIVERSITY OF NORTH CAROLINA AT GREENSBORO, DEPT OF ESS
Practice Address - Street 2:237B HHP BLDG
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27402
Practice Address - Country:US
Practice Address - Phone:336-334-3027
Practice Address - Fax:336-334-3238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer