Provider Demographics
NPI:1184822116
Name:SHARP, KEVIN M (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:SHARP
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 1:200 BIDDLE AVE.
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 SANDHILL DR STE 3
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5806
Practice Address - Country:US
Practice Address - Phone:302-449-7792
Practice Address - Fax:302-449-7791
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23893225100000X
DEJ10002241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP01052105OtherMEDICARE RAILROAD
1184822116OtherTRICARE CHAMPUS
MDP01052105OtherMEDICARE RAILROAD