Provider Demographics
NPI:1922077114
Name:GUTWIN, SHARON BARLOW (PT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:BARLOW
Last Name:GUTWIN
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 1:338 SOUTHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-5213
Mailing Address - Country:US
Mailing Address - Phone:802-878-7087
Mailing Address - Fax:
Practice Address - Street 1:30 HAWTHORNE ST
Practice Address - Street 2:SUITE 20
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8212
Practice Address - Country:US
Practice Address - Phone:802-876-6000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0001080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006925Medicaid
VT4682901OtherFAHC/VMC
VTP00056908OtherMEDICARE RAILROAD
VT363322OtherMVP
VT8046OtherBC/BS
VT230436OtherCIGNA
VT4470418OtherCIGNA NATIONAL
VT230436OtherCIGNA