Healthcare Provider Details

I. General information

NPI: 1053516468
Provider Name (Legal Business Name): S. SHARON MOLINE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAGHI SHARON SADEGHIAN PT

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 BESTGATE RD STE 220
ANNAPOLIS MD
21401-3648
US

IV. Provider business mailing address

13030 FOREST DR
BOWIE MD
20715-4344
US

V. Phone/Fax

Practice location:
  • Phone: 855-527-7246
  • Fax: 866-229-5063
Mailing address:
  • Phone: 301-675-3760
  • Fax: 240-766-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16169
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: