Provider Demographics
NPI:1912143975
Name:SCHOULTZ, MICHAEL ROBERT (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:SCHOULTZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 VALLER FORGE
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-249-5354
Mailing Address - Fax:501-229-2913
Practice Address - Street 1:1721 MLK BLVD
Practice Address - Street 2:STE I
Practice Address - City:MALVNER
Practice Address - State:AR
Practice Address - Zip Code:72104-2087
Practice Address - Country:US
Practice Address - Phone:501-229-2911
Practice Address - Fax:501-229-2913
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist