Provider Demographics
NPI:1003038597
Name:SHARP, REX LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:REX
Middle Name:LEE
Last Name:SHARP
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MIZZOU ATHLETICS TRAINING COMPLEX
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:65211-3030
Mailing Address - Country:US
Mailing Address - Phone:573-882-2375
Mailing Address - Fax:573-884-0692
Practice Address - Street 1:100 MIZZOU ATHLETICS TRAINING COMPLEX
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:65211-3030
Practice Address - Country:US
Practice Address - Phone:573-882-2375
Practice Address - Fax:573-884-0692
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1146292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer