Provider Demographics
NPI:1528286390
Name:MOUSTAKIS, SHARRONE ELIZA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SHARRONE
Middle Name:ELIZA
Last Name:MOUSTAKIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 W WELLINGTON AVE APT 704
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5606
Mailing Address - Country:US
Mailing Address - Phone:773-248-2203
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST
Practice Address - Street 2:DEPT 2C - PHYSICAL THERAPY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4319
Practice Address - Country:US
Practice Address - Phone:312-355-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist