Provider Demographics
NPI:1043596539
Name:GOLDBERG, SHARON O'DONNELL (PT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:O'DONNELL
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ANNE
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6116 OAKBEND TRL
Mailing Address - Street 2:STE 100
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3925
Mailing Address - Country:US
Mailing Address - Phone:817-336-8293
Mailing Address - Fax:817-336-9017
Practice Address - Street 1:6116 OAKBEND TRL
Practice Address - Street 2:STE 100
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3925
Practice Address - Country:US
Practice Address - Phone:817-336-8293
Practice Address - Fax:817-336-9017
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist