Provider Demographics
NPI:1861519704
Name:URIST, SHARYN (PT)
Entity type:Individual
Prefix:MS
First Name:SHARYN
Middle Name:
Last Name:URIST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SHARYN
Other - Middle Name:
Other - Last Name:GRUBER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:110 SARAH DR
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1269
Mailing Address - Country:US
Mailing Address - Phone:415-383-8028
Mailing Address - Fax:415-389-6872
Practice Address - Street 1:110 SARAH DR
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1269
Practice Address - Country:US
Practice Address - Phone:415-383-8028
Practice Address - Fax:415-389-6872
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ16482Medicare UPIN