Provider Demographics
NPI:1629248133
Name:CAMPBELL, SHARON MARIE (PT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:CAMPBELL
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 1:6203 KILMER ST
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1248
Mailing Address - Country:US
Mailing Address - Phone:301-772-3266
Mailing Address - Fax:
Practice Address - Street 1:9400 LIVINGSTON RD
Practice Address - Street 2:SUITE 260
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4958
Practice Address - Country:US
Practice Address - Phone:301-248-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist