Basic Information
| Provider Information | |||||||||
| NPI: | 1831445097 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUTLER | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CREDITO | ||||||||
| OtherFirstName: | SHARON | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10845 TOWN CENTER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DUNKIRK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207542712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102575263 | ||||||||
| FaxNumber: | 4102575341 | ||||||||
| Practice Location | |||||||||
| Address1: | 10845 TOWN CENTER BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | DUNKIRK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207542712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102575263 | ||||||||
| FaxNumber: | 4102575341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2012 | ||||||||
| LastUpdateDate: | 08/10/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 22639 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.