Provider Demographics
NPI:1346826351
Name:SCHULTZ, CODY ROBERT (PTA)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ROBERT
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 1:2638 MEADWELL CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4562
Mailing Address - Country:US
Mailing Address - Phone:614-557-9170
Mailing Address - Fax:
Practice Address - Street 1:10351 SAWMILL PKWY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9053
Practice Address - Country:US
Practice Address - Phone:614-793-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA011264225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant