Provider Demographics
NPI:1831593110
Name:SERGEANT, SHARON LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LEIGH
Last Name:SERGEANT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LEIGH
Other - Last Name:MOORE-SERGEANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:507 FORREST BROOK DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-2913
Mailing Address - Country:US
Mailing Address - Phone:609-404-9239
Mailing Address - Fax:
Practice Address - Street 1:507 FORREST BROOK DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-2913
Practice Address - Country:US
Practice Address - Phone:609-404-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01030200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist