Provider Demographics
NPI:1093836512
Name:HONICK, SHARON (RPT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:HONICK
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9223 W EARTH RD
Mailing Address - Street 2:
Mailing Address - City:BRAMAN
Mailing Address - State:OK
Mailing Address - Zip Code:74632-9137
Mailing Address - Country:US
Mailing Address - Phone:580-362-5351
Mailing Address - Fax:
Practice Address - Street 1:1209 E PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1746
Practice Address - Country:US
Practice Address - Phone:580-765-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist