MEDICARE: CHARLES ROBERT SCLATER MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	20886	MD
2	225100000X	Physical Therapist	20886	MD

General Provider Information

NPI Number	:	1164590295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ROBERT SCLATER MPT

Provider Business Mailing Address
First Line	:	8501 BAYSIDE RD
Second Line	:	SUITE C4
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732-3350
Country	:	US
Telephone Number	:	443-964-5656
Fax Number	:	443-964-5657

Provider Business Practice Location Address
First Line	:	8501 BAYSIDE RD
Second Line	:	SUITE C4
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732-3350
Country	:	US
Telephone Number	:	443-964-5656
Fax Number	:	443-965-5657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	03/17/2015

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