Provider Demographics
NPI:1841286341
Name:SHARMA, TINA (MPT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SHARMA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9269 OLD KEENE MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4202
Mailing Address - Country:US
Mailing Address - Phone:732-895-8668
Mailing Address - Fax:571-358-8800
Practice Address - Street 1:9269 OLD KEENE MILL RD STE A
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4202
Practice Address - Country:US
Practice Address - Phone:703-455-0115
Practice Address - Fax:571-358-8800
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist