Provider Demographics
NPI:1275710568
Name:STRANGE, SHARON DENISE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:DENISE
Last Name:STRANGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:DENISE
Other - Last Name:BURRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8490 SWAN LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5326
Mailing Address - Country:US
Mailing Address - Phone:318-688-1425
Mailing Address - Fax:
Practice Address - Street 1:8490 SWAN LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-5326
Practice Address - Country:US
Practice Address - Phone:318-688-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2002507225200000X
LAA3947R225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant