Healthcare Provider Details

I. General information

NPI: 1346507910
Provider Name (Legal Business Name): GABRIEL ETHAN SCHULTZ LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 74TH ST SE APT A
EVERETT WA
98203
US

IV. Provider business mailing address

2020 74TH ST SE APT A
EVERETT WA
98203-6836
US

V. Phone/Fax

Practice location:
  • Phone: 509-638-4166
  • Fax:
Mailing address:
  • Phone: 509-638-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60234849
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: