Provider Demographics
NPI:1912117433
Name:SCHULTZ, BRENDA JANE (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JANE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1719 945TH ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-1823
Mailing Address - Country:US
Mailing Address - Phone:715-875-4674
Mailing Address - Fax:
Practice Address - Street 1:N1719 945TH ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-1823
Practice Address - Country:US
Practice Address - Phone:715-875-4674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4045-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist