Provider Demographics
NPI:1770799496
Name:CAULKINS MOULTON, SHARON MARIE (PTA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MARIE
Last Name:CAULKINS MOULTON
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 1:4691 SLOAN ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1923
Mailing Address - Country:US
Mailing Address - Phone:510-438-9387
Mailing Address - Fax:
Practice Address - Street 1:39022 PRESIDIO WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1221
Practice Address - Country:US
Practice Address - Phone:510-792-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2597225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant