Provider Demographics
NPI:1689010068
Name:SCHULTZ, ERICA W (ATC,LAT)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:W
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 VILLAGE VIEW DR STE 314
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-0035
Mailing Address - Country:US
Mailing Address - Phone:678-234-7941
Mailing Address - Fax:
Practice Address - Street 1:12420 BAILEY RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-9134
Practice Address - Country:US
Practice Address - Phone:704-792-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0020692255A2300X
NCLAT-24402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer