Healthcare Provider Details

I. General information

NPI: 1013834241
Provider Name (Legal Business Name): DEEPAK SHARMA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 WILD SENNA TRL
MOSELEY VA
23120-1665
US

IV. Provider business mailing address

7307 WILD SENNA TRL
MOSELEY VA
23120-1665
US

V. Phone/Fax

Practice location:
  • Phone: 804-873-3336
  • Fax:
Mailing address:
  • Phone: 804-873-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206662
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: