Provider Demographics
NPI:1982736526
Name:SCHULTZ, SUSAN MARCIA (DPT)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:MARCIA
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4621
Mailing Address - Country:US
Mailing Address - Phone:516-781-1476
Mailing Address - Fax:
Practice Address - Street 1:2629 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4621
Practice Address - Country:US
Practice Address - Phone:516-781-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist