Provider Demographics
NPI:1124419130
Name:SCHULTES, GRANT
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:SCHULTES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4130 PIONEER WOODS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7552
Mailing Address - Country:US
Mailing Address - Phone:402-261-6841
Mailing Address - Fax:402-261-6843
Practice Address - Street 1:4130 PIONEER WOODS DR STE 3
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7552
Practice Address - Country:US
Practice Address - Phone:402-261-6841
Practice Address - Fax:402-261-6843
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073868225100000X
NE4742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist