Provider Demographics
NPI:1427131473
Name:SCHULTZ, DOUGLAS L (MPT ATC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MPT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 SOUTH ROCHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-601-9207
Mailing Address - Fax:248-650-8670
Practice Address - Street 1:48875 HAYES ROAD
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315
Practice Address - Country:US
Practice Address - Phone:586-532-9602
Practice Address - Fax:586-532-9605
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS01009271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7180463OtherAETNA
O71490Medicare ID - Type Unspecified