Provider Demographics
NPI:1184632937
Name:KELLY, SHARON (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 SW 158TH TER
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2476
Mailing Address - Country:US
Mailing Address - Phone:305-297-5865
Mailing Address - Fax:305-661-1443
Practice Address - Street 1:8603 S DIXIE HWY
Practice Address - Street 2:308
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7807
Practice Address - Country:US
Practice Address - Phone:305-661-1441
Practice Address - Fax:305-661-1443
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9831OtherBCBS
FLY9831ZMedicare ID - Type Unspecified