Provider Demographics
NPI:1346468865
Name:CARTER, SHARAE' MARIE PASCOE (DPT)
Entity Type:Individual
Prefix:DR
First Name:SHARAE'
Middle Name:MARIE PASCOE
Last Name:CARTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 OXBOW DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-6025
Mailing Address - Country:US
Mailing Address - Phone:719-522-9914
Mailing Address - Fax:
Practice Address - Street 1:317 OXBOW DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-6025
Practice Address - Country:US
Practice Address - Phone:719-522-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6738171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98353748Medicaid