Healthcare Provider Details

I. General information

NPI: 1962442582
Provider Name (Legal Business Name): SHARON ROSE ECRAELA YABUT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON ROSE ECRAELA YABUT PT

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 ROUTE 27 MULTICARE THERAPY CENTER , SUITE 1100
SOMERSET NJ
08873
US

IV. Provider business mailing address

2 MEADOWLARK LN
FRANKLIN PARK NJ
08823-1809
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-7474
  • Fax: 732-545-2880
Mailing address:
  • Phone: 732-422-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00352600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: