Provider Demographics
NPI:1508834722
Name:SCHULTZ, JEFFREY ROBERT (BS, ATC, R/L)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:BS, ATC, R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2373 S ROBERT CT
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5664
Mailing Address - Country:US
Mailing Address - Phone:847-201-7435
Mailing Address - Fax:
Practice Address - Street 1:555 CORPORATE WOODS PKWY
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-3111
Practice Address - Country:US
Practice Address - Phone:847-634-0400
Practice Address - Fax:847-634-2900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer