MEDICARE: MARK SCHULTHEIS P.T., S.C.S.C.

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	225100000X	Physical Therapist	5223	WI
2	225100000X	Physical Therapist	0635	WY

General Provider Information

NPI Number	:	1427034180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK SCHULTHEIS P.T., S.C.S.C.

Provider Business Mailing Address
First Line	:	PO BOX 8467
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-8467
Country	:	US
Telephone Number	:	307-733-5577
Fax Number	:	307-733-5505

Provider Business Practice Location Address
First Line	:	1090 S HIGHWAY 89
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002
Country	:	US
Telephone Number	:	307-733-5577
Fax Number	:	307-733-5505

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	10/19/2024

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