Provider Demographics
NPI:1285086074
Name:SCHULTZ, KAITLIN CAROL (DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:CAROL
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:CAROL
Other - Last Name:BRENDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4540 SNELLING AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4412
Mailing Address - Country:US
Mailing Address - Phone:715-296-5844
Mailing Address - Fax:
Practice Address - Street 1:4155 COUNTY ROAD 101 N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-2307
Practice Address - Country:US
Practice Address - Phone:952-993-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist