MEDICARE: MOLLY REESE SCHULTZ PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	8636	MN

General Provider Information

NPI Number	:	1063840403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY REESE SCHULTZ PT

Provider Business Mailing Address
First Line	:	3707 GRAND WAY APT 301
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55416-2754
Country	:	US
Telephone Number	:	952-905-6059
Fax Number	:

Provider Business Practice Location Address
First Line	:	1747 BEAM AVE
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1128
Country	:	US
Telephone Number	:	651-326-5569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	04/05/2022

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