Provider Demographics
NPI:1144850454
Name:ANCHETA, SHARON MAE DE SAGUN (PT,DPT)
Entity type:Individual
Prefix:
First Name:SHARON MAE
Middle Name:DE SAGUN
Last Name:ANCHETA
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:SHARON MAE
Other - Middle Name:
Other - Last Name:DE SAGUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1223 JACARANDA BLVD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-4520
Mailing Address - Country:US
Mailing Address - Phone:941-486-6420
Mailing Address - Fax:941-486-6421
Practice Address - Street 1:1223 JACARANDA BLVD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4520
Practice Address - Country:US
Practice Address - Phone:941-486-6420
Practice Address - Fax:941-486-6421
Is Sole Proprietor?:No
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist