Provider Demographics
NPI:1588739304
Name:JIA, SHARON XIAOYUN (DPT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:XIAOYUN
Last Name:JIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:XIAOYUN
Other - Middle Name:
Other - Last Name:JIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6314 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4121
Mailing Address - Country:US
Mailing Address - Phone:301-770-0628
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist