Provider Demographics
NPI:1437494721
Name:SHARPE, JENNIFER L (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SHARPE
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 1:4055 OCEANSIDE BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5821
Mailing Address - Country:US
Mailing Address - Phone:760-630-8400
Mailing Address - Fax:760-630-8594
Practice Address - Street 1:4055 OCEANSIDE BLVD
Practice Address - Street 2:STE C
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5821
Practice Address - Country:US
Practice Address - Phone:760-586-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10088225100000X
CAPT39553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist