Provider Demographics
NPI:1295974871
Name:SCHARES, CYNTHIA CATHERINE (DPT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CATHERINE
Last Name:SCHARES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:CATHERINE
Other - Last Name:GILLAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:219-844-8100
Mailing Address - Fax:
Practice Address - Street 1:1501 N MILFORD RD STE 201
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1049
Practice Address - Country:US
Practice Address - Phone:248-676-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-05
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018363225100000X
MI5501013260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION45090OtherMEDICARE GRP PTAN
ILP01054132OtherMEDICARE RAILROAD
MI5501013260OtherSTATE LICENSE NUMBER
MION45090OtherMEDICARE GRP PTAN
IL202845182Medicare PIN
INM48721009Medicare PIN