Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1259000 | TX |
NPI | 1003295965 |
---|---|
Provider Name | Luressa Schultz |
First Address | Lincoln, NE 68526-6032 |
Second Address | Crazy Horse, SD 57730-8900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 08/07/2015 |