Healthcare Provider Details

I. General information

NPI: 1700715372
Provider Name (Legal Business Name): LARISA GORGEVSKA-SHARPE MAT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 W ROOSEVELT RD
CHICAGO IL
60608-1531
US

IV. Provider business mailing address

104 CHESTNUT CT
ROYAL PALM BEACH FL
33411-8261
US

V. Phone/Fax

Practice location:
  • Phone: 561-631-0290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: