Provider Demographics
NPI:1588409916
Name:SCHULT, CLAY CLARENCE LEE
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:CLARENCE LEE
Last Name:SCHULT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 PREHN DR
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-9112
Mailing Address - Country:US
Mailing Address - Phone:715-470-3006
Mailing Address - Fax:
Practice Address - Street 1:340 E 1ST AVE STE 307
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2454
Practice Address - Country:US
Practice Address - Phone:646-330-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2251S0007X, 2251X0800X
COCP037131T2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports