Provider Demographics
NPI:1609110261
Name:HIBBERT-MCKENZIE, SHARON JAQUELINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:JAQUELINE
Last Name:HIBBERT-MCKENZIE
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 1:12 STRATFORD GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1560
Mailing Address - Country:US
Mailing Address - Phone:301-625-1789
Mailing Address - Fax:505-468-9956
Practice Address - Street 1:12 STRATFORD GARDEN CT
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1560
Practice Address - Country:US
Practice Address - Phone:301-625-1789
Practice Address - Fax:505-468-9956
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17602225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist