Provider Demographics
NPI:1558913202
Name:BERTHOLD, SHARI MCELWAIN (DPT)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:MCELWAIN
Last Name:BERTHOLD
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:UPMC SUSQUEHANNA-WENNER BUILDING
Mailing Address - Street 2:1705 WARREN AVE
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701
Mailing Address - Country:US
Mailing Address - Phone:570-320-7470
Mailing Address - Fax:570-320-7471
Practice Address - Street 1:1705 WARREN AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2647
Practice Address - Country:US
Practice Address - Phone:570-320-7470
Practice Address - Fax:570-320-7471
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000128225100000X
PAPT11809L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist