Provider Demographics
NPI:1982152559
Name:ROTENBERRY, SHARON MOSKO (MS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MOSKO
Last Name:ROTENBERRY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 JOSHUA WAY
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9439
Mailing Address - Country:US
Mailing Address - Phone:304-389-7089
Mailing Address - Fax:
Practice Address - Street 1:323 JOSHUA WAY
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-9439
Practice Address - Country:US
Practice Address - Phone:304-389-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist