Provider Demographics
NPI:1295949345
Name:PELFREY, SHARON L (PTA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:PELFREY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 EL CENTRO RD
Mailing Address - Street 2:APT 913
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2659
Mailing Address - Country:US
Mailing Address - Phone:530-268-0719
Mailing Address - Fax:
Practice Address - Street 1:4450 EL CENTRO RD
Practice Address - Street 2:APT 913
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2659
Practice Address - Country:US
Practice Address - Phone:530-268-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8099225200000X
NJ40QB00226100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant