Provider Demographics
NPI:1962889360
Name:SCHULTZ, ANGELA ELLEN (LMT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ELLEN
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 RIVERSIDE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4374
Mailing Address - Country:US
Mailing Address - Phone:970-493-4049
Mailing Address - Fax:970-493-4252
Practice Address - Street 1:1301 RIVERSIDE AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4374
Practice Address - Country:US
Practice Address - Phone:970-493-4049
Practice Address - Fax:970-493-4252
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0013447225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist