MEDICARE: MRS. JENORA SUE SCHULTZ MPT

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	2251P0200X	Pediatric Physical Therapist	PT 2508	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	027963	OTHER	ME	ANTHEM OR BLUECROSS

General Provider Information

NPI Number	:	1790896363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENORA SUE SCHULTZ MPT

Provider Business Mailing Address
First Line	:	9 COBBOSSEE RD
Second Line	:
City	:	MONMOUTH
State	:	ME
Zip	:	04259-7113
Country	:	US
Telephone Number	:	207-933-2484
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 COBBOSSEE RD
Second Line	:
City	:	MONMOUTH
State	:	ME
Zip	:	04259-7113
Country	:	US
Telephone Number	:	207-933-2484
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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