Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070021773 | IL |
N | 2251X0800X | Physical Therapist - Orthopedic | 070.021773 |
NPI | 1013535061 |
---|---|
Provider Name | Matthew Schultz |
First Address | Cherry Hill, NJ 08003-1000 |
Second Address | Peoria, IL 61614-2932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 24/11/2020 |