Provider Demographics
NPI:1588750210
Name:WERMUT, SHARON (PT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:WERMUT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 JULIAN LANE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1148
Mailing Address - Country:US
Mailing Address - Phone:818-789-4959
Mailing Address - Fax:818-789-4979
Practice Address - Street 1:14144 VENTURA BLVD.
Practice Address - Street 2:SUITE 120
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2763
Practice Address - Country:US
Practice Address - Phone:818-789-4959
Practice Address - Fax:818-789-4979
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT7582Medicare ID - Type UnspecifiedLICENSE NUMBER