Provider Demographics
NPI:1699907642
Name:SCHULTZ, ANDREA M (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OKATIE CENTER BLVD N
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-3750
Mailing Address - Country:US
Mailing Address - Phone:850-326-2329
Mailing Address - Fax:
Practice Address - Street 1:100 OKATIE CENTER BLVD N
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-3750
Practice Address - Country:US
Practice Address - Phone:843-547-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7093225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446631Medicaid
TN0446631Medicaid