Provider Demographics
NPI:1295967420
Name:MORITZ, SHARON E (PTA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:E
Last Name:MORITZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-3112
Mailing Address - Country:US
Mailing Address - Phone:630-681-6300
Mailing Address - Fax:630-681-6310
Practice Address - Street 1:455 SCOTT DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-3112
Practice Address - Country:US
Practice Address - Phone:630-681-6300
Practice Address - Fax:630-681-6310
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160001726225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant