Provider Demographics
NPI:1851321749
Name:SHARPLES-FAUCHER, BRAD EDWARD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:EDWARD
Last Name:SHARPLES-FAUCHER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9216
Mailing Address - Country:US
Mailing Address - Phone:208-777-9740
Mailing Address - Fax:208-777-8316
Practice Address - Street 1:104 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9216
Practice Address - Country:US
Practice Address - Phone:208-777-9740
Practice Address - Fax:208-777-8316
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806161100Medicaid
ID16536911Medicare PIN