Provider Demographics
NPI:1679523781
Name:NORTHCUTT, SHEILA ANNE (MS,PT, ATC, CLT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANNE
Last Name:NORTHCUTT
Suffix:
Gender:F
Credentials:MS,PT, ATC, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5904
Mailing Address - Country:US
Mailing Address - Phone:714-288-8303
Mailing Address - Fax:714-744-1991
Practice Address - Street 1:1045 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5904
Practice Address - Country:US
Practice Address - Phone:714-288-8303
Practice Address - Fax:714-744-1991
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
208737315OtherTRICARE
2Z7238OtherHEALTHNET
AZ1386864262OtherBCBS OF AZ
208737315OtherTRICARE
CAGN679ZMedicare PIN
AZ109209Medicare PIN
2Z7238OtherHEALTHNET