=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598973034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARLYN TOLENTINO P.T
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 07/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3401 SOLDIERS HOME RD
-----------------------------------------------------
City | WEST LAFAYETTE BRA
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47906-1222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-463-1541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3507 CORTEZ DRIVE APT.33
-----------------------------------------------------
City | WEST LAFAYETTE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-409-5184
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT30265
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------