Provider Demographics
NPI:1578670352
Name:SMITH, SHARON LEE (LPT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14133 N 920 EAST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMOUNT
Mailing Address - State:IL
Mailing Address - Zip Code:61841-6343
Mailing Address - Country:US
Mailing Address - Phone:217-427-2410
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:217-554-5235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist