Provider Demographics
NPI:1528477635
Name:SCHILTZ, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SCHILTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-639-9699
Practice Address - Street 1:3400 STATE ST
Practice Address - Street 2:SUITE G-704
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5861
Practice Address - Country:US
Practice Address - Phone:503-378-7434
Practice Address - Fax:503-362-2703
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500676654Medicaid
ORR177721Medicare PIN