Provider Demographics
NPI:1902001993
Name:THOMASON, SHARON AQUILA (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:AQUILA
Last Name:THOMASON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-7477
Mailing Address - Country:US
Mailing Address - Phone:712-256-2286
Mailing Address - Fax:
Practice Address - Street 1:7350 GRACELAND DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-4328
Practice Address - Country:US
Practice Address - Phone:402-557-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE663225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant