Provider Demographics
NPI:1558659664
Name:STONE, SHARON SAMSON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:SAMSON
Last Name:STONE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:SAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:85 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2423
Mailing Address - Country:US
Mailing Address - Phone:207-774-7751
Mailing Address - Fax:
Practice Address - Street 1:85 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2423
Practice Address - Country:US
Practice Address - Phone:207-774-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010242225100000X
MEPT4211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist