Provider Demographics
NPI:1679546287
Name:SCHARICH, MARK DAVID (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:SCHARICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6698 ADARIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9139
Mailing Address - Country:US
Mailing Address - Phone:616-682-8339
Mailing Address - Fax:
Practice Address - Street 1:6698 ADARIDGE DR SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9139
Practice Address - Country:US
Practice Address - Phone:616-682-8339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP35130001Medicare PIN