MEDICARE: JACQUELINE SHARON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	33669	FL

General Provider Information

NPI Number	:	1619761095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SHARON PTA

Provider Business Mailing Address
First Line	:	581 SE 13TH ST APT 205
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-4663
Country	:	US
Telephone Number	:	570-407-3362
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 E DANIA BEACH BLVD
Second Line	:
City	:	DANIA
State	:	FL
Zip	:	33004-3020
Country	:	US
Telephone Number	:	954-920-5050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	04/08/2025

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Directions to “ JACQUELINE SHARON PTA” Practice Location

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