Basic Information
| Provider Information | |||||||||
| NPI: | 1164590295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCLATER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8501 BAYSIDE RD | ||||||||
| Address2: | SUITE C4 | ||||||||
| City: | CHESAPEAKE BEACH | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207323350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439645656 | ||||||||
| FaxNumber: | 4439645657 | ||||||||
| Practice Location | |||||||||
| Address1: | 8501 BAYSIDE RD | ||||||||
| Address2: | SUITE C4 | ||||||||
| City: | CHESAPEAKE BEACH | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207323350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439645656 | ||||||||
| FaxNumber: | 4439655657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 03/17/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 20886 | MD | N | Other Service Providers | Specialist | 225100000X | 20886 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.