Provider Demographics
NPI:1275396822
Name:SCHULTZ, MICHAEL BRADFORD (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRADFORD
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5329
Mailing Address - Country:US
Mailing Address - Phone:817-916-0878
Mailing Address - Fax:817-916-0879
Practice Address - Street 1:437 SW WILSHIRE
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028
Practice Address - Country:US
Practice Address - Phone:817-916-0878
Practice Address - Fax:817-916-0879
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2166131225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant