Provider Demographics
NPI:1073839197
Name:SHEAMANSMITH, CHARLENE MARIE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:MARIE
Last Name:SHEAMANSMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 E PERSHING BLVD UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6093
Mailing Address - Country:US
Mailing Address - Phone:307-778-7554
Mailing Address - Fax:
Practice Address - Street 1:4515 E PERSHING BLVD UNIT C
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:307-635-2388
Practice Address - Fax:307-635-1730
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT1287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist