Provider Demographics
NPI:1629032099
Name:WING, SHARLENE W (PT)
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:W
Last Name:WING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2705
Mailing Address - Country:US
Mailing Address - Phone:617-629-6040
Mailing Address - Fax:617-629-6057
Practice Address - Street 1:40 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2705
Practice Address - Country:US
Practice Address - Phone:617-629-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0309958Medicaid
MAB501027OtherCIGNA
MA908025OtherTUFTS HEALTH PLAN
MA0014440OtherNEIGHBORHOOD HEALTH PLAN
MAHV0001OtherHARVARD PILGRIM
MAY67456OtherBLUE CROSS
MAP00026183OtherMEDICARE RAILROAD
MAS85465Medicare UPIN
MA0309958Medicaid