Healthcare Provider Details

I. General information

NPI: 1598973034
Provider Name (Legal Business Name): SHARLYN TOLENTINO P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARLYN BAGWAN

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 SOLDIERS HOME RD
WEST LAFAYETTE BRA IN
47906-1222
US

IV. Provider business mailing address

3507 CORTEZ DRIVE APT.33
WEST LAFAYETTE IN
47906
US

V. Phone/Fax

Practice location:
  • Phone: 765-463-1541
  • Fax:
Mailing address:
  • Phone: 765-409-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30265
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: