Provider Demographics
NPI:1346593571
Name:SCHULTZ, TRACY (CMT)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 EMMETTSBURG ST
Mailing Address - Street 2:48
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-4519
Mailing Address - Country:US
Mailing Address - Phone:219-771-8697
Mailing Address - Fax:
Practice Address - Street 1:259 INDIANA AVE
Practice Address - Street 2:48
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5573
Practice Address - Country:US
Practice Address - Phone:219-771-8697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21104195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist