Provider Demographics
NPI:1225623135
Name:SHULTZ, GREGORY JR (DPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:SHULTZ
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SCHOOL HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:PA
Mailing Address - Zip Code:17847-7912
Mailing Address - Country:US
Mailing Address - Phone:570-412-1253
Mailing Address - Fax:
Practice Address - Street 1:1100 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2214
Practice Address - Country:US
Practice Address - Phone:510-880-3768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist