Provider Demographics
NPI:1568657799
Name:WHITEHEAD, SHARON MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MICHELLE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10229 TIMBER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-6026
Mailing Address - Country:US
Mailing Address - Phone:214-704-4757
Mailing Address - Fax:214-956-7812
Practice Address - Street 1:10229 TIMBER TRAIL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-6026
Practice Address - Country:US
Practice Address - Phone:214-704-4757
Practice Address - Fax:214-956-7812
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist