Provider Demographics
NPI:1073679114
Name:RANDALL, SHARON RAE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RAE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1498
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-1498
Mailing Address - Country:US
Mailing Address - Phone:775-267-4175
Mailing Address - Fax:
Practice Address - Street 1:2255 GREEN VISTA DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8534
Practice Address - Country:US
Practice Address - Phone:775-673-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist