Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00007835 | WA |
NPI | 1003158510 |
---|---|
Provider Name | Terry Kelly Shultz |
First Address | Kennewick, WA 99337-2887 |
Second Address | Kennewick, WA 99337-2887 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 22/03/2013 |