Provider Demographics
NPI:1578526646
Name:SHEATS, CAROL (PT, OSC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SHEATS
Suffix:
Gender:F
Credentials:PT, OSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3478
Mailing Address - Country:US
Mailing Address - Phone:302-741-0200
Mailing Address - Fax:302-741-0245
Practice Address - Street 1:1404 FORREST AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3478
Practice Address - Country:US
Practice Address - Phone:302-741-0200
Practice Address - Fax:302-741-0245
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000569225100000X, 2251G0304X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
1578526646OtherCHAMPUS TRICARE
91453501OtherNCA
5070-0066OtherCAREFIRST
DE2625869000OtherAMERIHEALTH
1578526646OtherCHAMPUS TRICARE
DEP89774Medicare UPIN