Provider Demographics
NPI:1790896363
Name:SCHULTZ, JENORA SUE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENORA
Middle Name:SUE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 COBBOSSEE RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04259-7113
Mailing Address - Country:US
Mailing Address - Phone:207-933-2484
Mailing Address - Fax:
Practice Address - Street 1:9 COBBOSSEE RD
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259-7113
Practice Address - Country:US
Practice Address - Phone:207-933-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT 25082251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027963OtherANTHEM OR BLUECROSS