Provider Demographics
NPI:1720660780
Name:MARBETH, SHARON LOUISE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LOUISE
Last Name:MARBETH
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 1:2635 CHURCH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8942
Mailing Address - Country:US
Mailing Address - Phone:630-933-1500
Mailing Address - Fax:630-933-1550
Practice Address - Street 1:2635 CHURCH RD STE 103
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-8943
Practice Address - Country:US
Practice Address - Phone:630-933-1500
Practice Address - Fax:630-933-1550
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist