Healthcare Provider Details

I. General information

NPI: 1982152559
Provider Name (Legal Business Name): SHARON MOSKO ROTENBERRY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 JOSHUA WAY
WINFIELD WV
25213-9439
US

IV. Provider business mailing address

323 JOSHUA WAY
WINFIELD WV
25213-9439
US

V. Phone/Fax

Practice location:
  • Phone: 304-389-7089
  • Fax:
Mailing address:
  • Phone: 304-389-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: