Provider Demographics
NPI:1669674503
Name:AUTRY, SHARON LEIGH (PTA)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LEIGH
Last Name:AUTRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:LEIGH
Other - Last Name:OAKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:2005 CROOKED CREEK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4522
Mailing Address - Country:US
Mailing Address - Phone:210-403-3369
Mailing Address - Fax:
Practice Address - Street 1:106 LINDSEYS CV
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7755
Practice Address - Country:US
Practice Address - Phone:210-735-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2005922225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant