Provider Demographics
NPI:1215009931
Name:SHEARON, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SHEARON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 FEE FEE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3807
Mailing Address - Country:US
Mailing Address - Phone:314-469-2146
Mailing Address - Fax:
Practice Address - Street 1:929 FEE FEE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3807
Practice Address - Country:US
Practice Address - Phone:314-469-2146
Practice Address - Fax:314-205-1762
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist