Provider Demographics
NPI:1093961633
Name:OPDYKE, SHARON B (L/PTA)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:B
Last Name:OPDYKE
Suffix:
Gender:F
Credentials:L/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 OLD COLUMBIA RD
Mailing Address - Street 2:SUITE B-215
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1703
Mailing Address - Country:US
Mailing Address - Phone:443-426-0919
Mailing Address - Fax:
Practice Address - Street 1:10015 OLD COLUMBIA RD
Practice Address - Street 2:SUITE B-215
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1703
Practice Address - Country:US
Practice Address - Phone:443-426-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1935225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant