Provider Demographics
NPI:1053798389
Name:SCHULTZ, STEFANIE (PTA)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 140TH AVE NE
Mailing Address - Street 2:SUITE E110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1862
Mailing Address - Country:US
Mailing Address - Phone:425-644-4100
Mailing Address - Fax:
Practice Address - Street 1:607 SE EVERETT MALL WAY
Practice Address - Street 2:SUITE 6B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3248
Practice Address - Country:US
Practice Address - Phone:425-644-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160272750225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant