Provider Demographics
NPI:1801230552
Name:ANDERSON, SHARON KAY (P T)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 PARKCREST PL NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4251
Mailing Address - Country:US
Mailing Address - Phone:770-578-1333
Mailing Address - Fax:770-578-6142
Practice Address - Street 1:660 PARKCREST PL NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4251
Practice Address - Country:US
Practice Address - Phone:770-578-1333
Practice Address - Fax:770-578-6142
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT000621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist