Provider Demographics
NPI:1598973034
Name:TOLENTINO, SHARLYN (PT)
Entity type:Individual
Prefix:MISS
First Name:SHARLYN
Middle Name:
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHARLYN
Other - Middle Name:
Other - Last Name:BAGWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3507 CORTEZ DRIVE
Mailing Address - Street 2:APT.33
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906
Mailing Address - Country:US
Mailing Address - Phone:765-409-5184
Mailing Address - Fax:
Practice Address - Street 1:3401 SOLDIERS HOME RD
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE BRA
Practice Address - State:IN
Practice Address - Zip Code:47906-1222
Practice Address - Country:US
Practice Address - Phone:765-463-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist