Provider Demographics
NPI:1861271215
Name:SHULER, ROOSEVELT JR (COACH)
Entity type:Individual
Prefix:
First Name:ROOSEVELT
Middle Name:
Last Name:SHULER
Suffix:JR
Gender:M
Credentials:COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 VAN BUREN ST # B
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-2230
Mailing Address - Country:US
Mailing Address - Phone:219-616-3067
Mailing Address - Fax:
Practice Address - Street 1:709 VAN BUREN ST # B
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-2230
Practice Address - Country:US
Practice Address - Phone:219-616-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN223754171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach