Provider Demographics
NPI:1013325596
Name:SHOULTZ, CASSANDRA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SHOULTZ
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 1:3117 PARTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7500
Mailing Address - Country:US
Mailing Address - Phone:918-914-9957
Mailing Address - Fax:
Practice Address - Street 1:100 W OAKDALE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-6833
Practice Address - Country:US
Practice Address - Phone:972-600-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT29942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer