Provider Demographics
NPI:1215203278
Name:HEFTY, SHARON M
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:HEFTY
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 1:1701 S WAVERLY RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4300
Mailing Address - Country:US
Mailing Address - Phone:517-367-7851
Mailing Address - Fax:517-367-7857
Practice Address - Street 1:1701 S WAVERLY RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4300
Practice Address - Country:US
Practice Address - Phone:517-367-7851
Practice Address - Fax:517-367-7857
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist