Provider Demographics
NPI:1518003268
Name:ROTH, SHARON (OMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8424 DRY CLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7155
Mailing Address - Country:US
Mailing Address - Phone:702-259-6996
Mailing Address - Fax:702-259-6995
Practice Address - Street 1:101 S RAINBOW BLVD STE 22
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-5371
Practice Address - Country:US
Practice Address - Phone:702-259-6996
Practice Address - Fax:702-259-6995
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV100171100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist