Provider Demographics
NPI:1558741397
Name:RICHARD, SHARON (LMT, NCTMB, RYT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:LMT, NCTMB, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 TRINITY MILLS RD
Mailing Address - Street 2:1516
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6274
Mailing Address - Country:US
Mailing Address - Phone:214-901-1831
Mailing Address - Fax:
Practice Address - Street 1:3628 FRANKFORD RD
Practice Address - Street 2:245
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6159
Practice Address - Country:US
Practice Address - Phone:214-901-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT024395225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist