Provider Demographics
NPI:1629277504
Name:JOHNSON, SHARA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHARA
Middle Name:L
Last Name:JOHNSON
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 1:210 WEST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:KS
Mailing Address - Zip Code:67756
Mailing Address - Country:US
Mailing Address - Phone:785-332-2104
Mailing Address - Fax:785-332-2673
Practice Address - Street 1:210 WEST 1ST STREET
Practice Address - Street 2:
Practice Address - City:SAINT FRANCIS
Practice Address - State:KS
Practice Address - Zip Code:67756
Practice Address - Country:US
Practice Address - Phone:785-332-2104
Practice Address - Fax:785-332-2673
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist