Healthcare Provider Details

I. General information

NPI: 1629543871
Provider Name (Legal Business Name): HALEY SCHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 GOSLING RD
SPRING TX
77381-3596
US

IV. Provider business mailing address

140 TAMBARISK LN
CONROE TX
77304-1150
US

V. Phone/Fax

Practice location:
  • Phone: 281-296-9234
  • Fax:
Mailing address:
  • Phone: 936-494-8907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2097606
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: