MEDICARE: MRS. ANGELA ELLEN SCHULTZ L.M.T.

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	MT.0013447	CO

General Provider Information

NPI Number	:	1962889360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA ELLEN SCHULTZ L.M.T.

Provider Business Mailing Address
First Line	:	1301 RIVERSIDE AVE STE 2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4374
Country	:	US
Telephone Number	:	970-493-4049
Fax Number	:	970-493-4252

Provider Business Practice Location Address
First Line	:	1301 RIVERSIDE AVE STE 2
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4374
Country	:	US
Telephone Number	:	970-493-4049
Fax Number	:	970-493-4252

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

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	05/06/2015

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