Provider Demographics
NPI:1225643190
Name:SCHULTZ, KARLY J (PTA)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:J
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5280 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2824
Mailing Address - Country:US
Mailing Address - Phone:262-210-5382
Mailing Address - Fax:
Practice Address - Street 1:575 TANTRA DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6195
Practice Address - Country:US
Practice Address - Phone:720-594-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant