Healthcare Provider Details

I. General information

NPI: 1144850454
Provider Name (Legal Business Name): SHARON MAE DE SAGUN ANCHETA PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON MAE DE SAGUN PT, DPT

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 01/26/2020
Certification Date: 01/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 JACARANDA BLVD
VENICE FL
34292-4520
US

IV. Provider business mailing address

1223 JACARANDA BLVD
VENICE FL
34292-4520
US

V. Phone/Fax

Practice location:
  • Phone: 941-486-6420
  • Fax: 941-486-6421
Mailing address:
  • Phone: 941-486-6420
  • Fax: 941-486-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: