Basic Information
| Provider Information | |||||||||
| NPI: | 1003295965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHULTZ | ||||||||
| FirstName: | LURESSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8901 ANDERMATT DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685266032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054400728 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12151 AVENUE OF THE CHIEFS | ||||||||
| Address2: | |||||||||
| City: | CRAZY HORSE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577308900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054400728 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2015 | ||||||||
| LastUpdateDate: | 07/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1259000 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.