Provider Demographics
NPI:1871638049
Name:FROST, SHARON LEE (MSPT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:FROST
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772175
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577
Mailing Address - Country:US
Mailing Address - Phone:907-696-5901
Mailing Address - Fax:907-696-5902
Practice Address - Street 1:12812 OLD GLENN HWY STE C-4
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7558
Practice Address - Country:US
Practice Address - Phone:907-696-5901
Practice Address - Fax:907-696-5902
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT51191Medicaid
AKPT51191Medicaid