Provider Demographics
NPI:1568592392
Name:SHARP, JESSICA M (MPT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:M
Last Name:SHARP
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:SANDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:839 HUNTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-9417
Mailing Address - Country:US
Mailing Address - Phone:219-926-6694
Mailing Address - Fax:
Practice Address - Street 1:3101 EVANS AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6939
Practice Address - Country:US
Practice Address - Phone:219-462-0786
Practice Address - Fax:219-548-7543
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007006A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist