Provider Demographics
NPI:1790841872
Name:SHARKEY, THOMAS W (LMT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:SHARKEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 SHEPHERD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1448
Mailing Address - Country:US
Mailing Address - Phone:850-763-2575
Mailing Address - Fax:
Practice Address - Street 1:910 CHERRY ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3858
Practice Address - Country:US
Practice Address - Phone:850-763-8133
Practice Address - Fax:850-763-8132
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43548225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist