Provider Demographics
NPI:1073092490
Name:SCHULTZ, SEAN ESQUIPULA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ESQUIPULA
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 CIPRIANO SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3835
Mailing Address - Country:US
Mailing Address - Phone:202-365-7572
Mailing Address - Fax:
Practice Address - Street 1:4907 NIAGARA RD STE 102
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1100
Practice Address - Country:US
Practice Address - Phone:240-206-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR02397225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist