MEDICARE: MICHAEL DAVID SCHULTZ LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	12944	OR

General Provider Information

NPI Number	:	1679625065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID SCHULTZ LMT

Provider Business Mailing Address
First Line	:	6220 SE MITCHELL ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-4664
Country	:	US
Telephone Number	:	503-774-1513
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 SE MITCHELL ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-4664
Country	:	US
Telephone Number	:	503-774-1513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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