Provider Demographics
NPI:1033582960
Name:LEE, SHARON ANN
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:ANN
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:103 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-2416
Mailing Address - Country:US
Mailing Address - Phone:209-599-7073
Mailing Address - Fax:209-599-7074
Practice Address - Street 1:103 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-2416
Practice Address - Country:US
Practice Address - Phone:209-599-7073
Practice Address - Fax:209-599-7074
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18198ZOtherPTAN
CAZZZ18198ZOtherPTAN
CA680273867OtherEIN