Individual
SHARESE JOELL DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
1015 W 47TH ST, NORFOLK, VA 23508
(757) 683-7041
Mailing address
728 CORAPEAKE DR, CHESAPEAKE, VA 23322-7914
(577) 353-7653
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
05/28/2019
Last updated
05/28/2019
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