Provider Demographics
NPI:1497979520
Name:BURTON, SHARON RENEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:RENEE
Last Name:BURTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:RENEE
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:567 SMITH COUNTY ROAD 83-A
Mailing Address - Street 2:
Mailing Address - City:MIZE
Mailing Address - State:MS
Mailing Address - Zip Code:39116
Mailing Address - Country:US
Mailing Address - Phone:601-733-0033
Mailing Address - Fax:
Practice Address - Street 1:301 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3625
Practice Address - Country:US
Practice Address - Phone:601-849-9882
Practice Address - Fax:601-849-9871
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA3320225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant