Provider Demographics
NPI:1518264720
Name:SCHULTZ, TODD R (PTA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:R
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 1:67965 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-1468
Mailing Address - Country:US
Mailing Address - Phone:586-336-0070
Mailing Address - Fax:586-336-0071
Practice Address - Street 1:67965 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-1468
Practice Address - Country:US
Practice Address - Phone:586-336-0070
Practice Address - Fax:586-336-0071
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002985225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant