Provider Demographics
NPI:1982812673
Name:WENTWORTH, SHARON BETH (DPT, MSPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:BETH
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:DPT, MSPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 WEST PARK AVE.
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07712
Mailing Address - Country:US
Mailing Address - Phone:732-544-0011
Mailing Address - Fax:732-544-1115
Practice Address - Street 1:1540 WEST PARK AVE.
Practice Address - Street 2:SUITE 4
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07712
Practice Address - Country:US
Practice Address - Phone:732-544-0011
Practice Address - Fax:732-544-1115
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00803600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ274409938OtherTAX ID NUMBER