Provider Demographics
NPI:1861568362
Name:HALL, SHARON P (PT)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:P
Last Name:HALL
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 1:1515 INDIAN RIVER BLVD
Mailing Address - Street 2:SUITE A 135
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-978-9750
Mailing Address - Fax:772-978-9748
Practice Address - Street 1:13000 US HIGHWAY 1
Practice Address - Street 2:SUITE 7
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:772-581-8326
Practice Address - Fax:772-978-9748
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y046Y2Medicare ID - Type Unspecified