Provider Demographics
NPI:1104979756
Name:MCCALLUM, SHARON E (PT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 27TH PL W APT 205
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-2055
Mailing Address - Country:US
Mailing Address - Phone:206-419-4252
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON SUITE #200
Practice Address - Street 2:OUTPATIENT REHAB SERVICES - SWEDISH MEDICAL CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-4307
Practice Address - Country:US
Practice Address - Phone:206-386-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039585OtherLABOR AND INDUSTRIES#
WAUS1051957OtherAETNA SPECIALIST PIN
WAMC2179OtherBLUE SHIELD #