Provider Demographics
NPI:1588844765
Name:SCHULTZ, JEROMY T (PT)
Entity Type:Individual
Prefix:MR
First Name:JEROMY
Middle Name:T
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 E CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-8000
Mailing Address - Country:US
Mailing Address - Phone:740-753-4567
Mailing Address - Fax:740-753-4626
Practice Address - Street 1:187 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1315
Practice Address - Country:US
Practice Address - Phone:740-592-4778
Practice Address - Fax:740-592-2244
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist