Provider Demographics
NPI:1639195548
Name:NOL, SHERWIN RODRIGUEZ (PT)
Entity Type:Individual
Prefix:
First Name:SHERWIN
Middle Name:RODRIGUEZ
Last Name:NOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHERWIN
Other - Middle Name:RAQUENO
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6620 CRAIN HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-4273
Mailing Address - Country:US
Mailing Address - Phone:301-861-4009
Mailing Address - Fax:301-861-4032
Practice Address - Street 1:6620 CRAIN HWY STE 101
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4273
Practice Address - Country:US
Practice Address - Phone:301-861-4009
Practice Address - Fax:301-861-4032
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC46950021OtherBLUECROSSBLUESHIELDPROV#