Provider Demographics
NPI:1922506369
Name:SHARKO, SUSAN (DPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHARKO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:SHARKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FREESE
Mailing Address - Street 1:40680 CALIFORNIA OAKS RD
Mailing Address - Street 2:STE 2A
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5755
Mailing Address - Country:US
Mailing Address - Phone:951-894-4800
Mailing Address - Fax:951-894-4804
Practice Address - Street 1:31741 TEMECULA PKWY STE C
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6800
Practice Address - Country:US
Practice Address - Phone:951-719-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2939975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist