Provider Demographics
NPI:1598881807
Name:SIMS, SHARON LEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:SIMS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LEE
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12230 RIVER VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-6272
Mailing Address - Country:US
Mailing Address - Phone:239-223-0484
Mailing Address - Fax:239-790-0969
Practice Address - Street 1:12230 RIVER VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-6272
Practice Address - Country:US
Practice Address - Phone:239-223-0484
Practice Address - Fax:239-790-0969
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBJ323ZMedicare PIN