Healthcare Provider Details

I. General information

NPI: 1689930752
Provider Name (Legal Business Name): ERIC DEAN SCHULTZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E BROADWAY SUITE 340
COLUMBIA MO
65203-4208
US

IV. Provider business mailing address

111 E BROADWAY SUITE 340
COLUMBIA MO
65203-4208
US

V. Phone/Fax

Practice location:
  • Phone: 573-268-4524
  • Fax:
Mailing address:
  • Phone: 573-268-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number2010028179
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: