Provider Demographics
NPI:1114291077
Name:SHARROW, RYAN (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SHARROW
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E SUPERIOR ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2253
Mailing Address - Country:US
Mailing Address - Phone:218-723-8999
Mailing Address - Fax:
Practice Address - Street 1:925 E SUPERIOR ST STE 104
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2253
Practice Address - Country:US
Practice Address - Phone:218-723-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7387225100000X
WI10960-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist