Provider Demographics
NPI:1518368240
Name:SHULTZ, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 US HIGHWAY 522 S
Mailing Address - Street 2:
Mailing Address - City:MC VEYTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17051-9429
Mailing Address - Country:US
Mailing Address - Phone:814-542-8630
Mailing Address - Fax:814-542-2828
Practice Address - Street 1:2109 US HIGHWAY 522 S
Practice Address - Street 2:
Practice Address - City:MC VEYTOWN
Practice Address - State:PA
Practice Address - Zip Code:17051-9429
Practice Address - Country:US
Practice Address - Phone:814-542-8630
Practice Address - Fax:814-542-2828
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010804L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist