Provider Demographics
NPI:1407125925
Name:SCHULTZ, ADAM EZEKIEL (MSPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:EZEKIEL
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2442
Mailing Address - Country:US
Mailing Address - Phone:213-617-2947
Mailing Address - Fax:213-617-2903
Practice Address - Street 1:708 W 1ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2442
Practice Address - Country:US
Practice Address - Phone:213-617-2947
Practice Address - Fax:213-617-2903
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic