Provider Demographics
NPI:1013169374
Name:SCHULZ, ANDREA LYNN (MSPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 PHEASANT RUN RD
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-4917
Mailing Address - Country:US
Mailing Address - Phone:605-697-6041
Mailing Address - Fax:
Practice Address - Street 1:1312 PHEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-4917
Practice Address - Country:US
Practice Address - Phone:605-697-6041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist