Provider Demographics
NPI:1942758297
Name:STULTZ, SELMA UMAR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:UMAR
Last Name:STULTZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 W VICTORIA LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1136
Mailing Address - Country:US
Mailing Address - Phone:301-875-5049
Mailing Address - Fax:
Practice Address - Street 1:6402 W VICTORIA LN
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1136
Practice Address - Country:US
Practice Address - Phone:301-875-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT291979225100000X
AZLPT-32058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist