Provider Demographics
NPI:1720531486
Name:MERKAM, SASHA
Entity Type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:MERKAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10125 VERREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3611
Mailing Address - Country:US
Mailing Address - Phone:215-676-3870
Mailing Address - Fax:215-676-6856
Practice Address - Street 1:10125 VERREE RD STE 100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3611
Practice Address - Country:US
Practice Address - Phone:215-676-3870
Practice Address - Fax:215-676-6856
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010715225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant