Provider Demographics
NPI:1346416294
Name:MOXLEY, SHARYN IRENE (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:SHARYN
Middle Name:IRENE
Last Name:MOXLEY
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 HALEY ST
Mailing Address - Street 2:PO BOX 739
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556
Mailing Address - Country:US
Mailing Address - Phone:870-368-7955
Mailing Address - Fax:870-368-4920
Practice Address - Street 1:1013 HALEY STREET
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556
Practice Address - Country:US
Practice Address - Phone:870-368-7955
Practice Address - Fax:870-368-4920
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 1776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129950721Medicaid