Provider Demographics
NPI:1780936880
Name:SCHULMAN, MATTHEW JARED (LMT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JARED
Last Name:SCHULMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 NE OREGON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2446
Mailing Address - Country:US
Mailing Address - Phone:541-227-3641
Mailing Address - Fax:
Practice Address - Street 1:2817 NE OREGON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2446
Practice Address - Country:US
Practice Address - Phone:541-227-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14251225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist