Provider Demographics
NPI:1578647533
Name:SCHULTZ, MANDI (DPT)
Entity Type:Individual
Prefix:DR
First Name:MANDI
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 22ND AVE NW
Mailing Address - Street 2:ROCHESTER
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-0519
Mailing Address - Country:US
Mailing Address - Phone:507-536-4819
Mailing Address - Fax:507-288-2082
Practice Address - Street 1:3411 22ND AVE NW
Practice Address - Street 2:ROCHESTER
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-0519
Practice Address - Country:US
Practice Address - Phone:507-536-4819
Practice Address - Fax:507-288-2082
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN504177500Medicare ID - Type UnspecifiedPROVIDER NUMBER