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NPI Code Detail

MEDICARE: IAN SHULTIS PT, ATC

MEDICARE: IAN SHULTIS PT, ATC
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
12255A2300XAthletic Trainer002788NY
2225100000XPhysical Therapist048547NY

General Provider Information

NPI Number : 1841689049
Entity Type Code : Individual
Provider Name (Legal Business Name) : IAN SHULTIS PT, ATC
Provider Business Mailing Address
First Line : 1311 MAMARONECK AVE STE 140
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5224
Country : US
Telephone Number : 914-294-4050
Fax Number :
Provider Business Practice Location Address
First Line : 2 FRONT ST
Second Line :
City : MILLBROOK
State : NY
Zip : 12545-5948
Country : US
Telephone Number : 845-677-5021
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2015
Last Update Date : 09/17/2024

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