Provider Demographics
NPI:1962567453
Name:SHARMA, KELLY RASTOGI (PT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:RASTOGI
Last Name:SHARMA
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 1:3219 RT 46E
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054
Mailing Address - Country:US
Mailing Address - Phone:973-299-2199
Mailing Address - Fax:973-299-2188
Practice Address - Street 1:3219 RT 46E
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054
Practice Address - Country:US
Practice Address - Phone:973-299-2199
Practice Address - Fax:973-299-2188
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist