Provider Demographics
NPI:1861039810
Name:SCHULTZ, RACHEL (ATC, DPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:ATC, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BRADLEY DR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-2332
Mailing Address - Country:US
Mailing Address - Phone:845-807-2696
Mailing Address - Fax:
Practice Address - Street 1:1500 NY-112
Practice Address - Street 2:BUILDING 9
Practice Address - City:PORT JEFFERSON STATTION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-849-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist