Provider Demographics
NPI:1760554802
Name:SHARP, MARILYNN MARIE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARILYNN
Middle Name:MARIE
Last Name:SHARP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 REBECCA RD
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:TN
Mailing Address - Zip Code:38469
Mailing Address - Country:US
Mailing Address - Phone:931-853-6838
Mailing Address - Fax:
Practice Address - Street 1:993 E COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478
Practice Address - Country:US
Practice Address - Phone:931-363-3572
Practice Address - Fax:931-363-5001
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA3440225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant