Provider Demographics
NPI:1841793981
Name:JOHNSON-SHULTZ, MARIA LESLIE (PTA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LESLIE
Last Name:JOHNSON-SHULTZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-1326
Mailing Address - Country:US
Mailing Address - Phone:712-266-4118
Mailing Address - Fax:
Practice Address - Street 1:3200 G ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3339
Practice Address - Country:US
Practice Address - Phone:402-494-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE748225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant