Provider Demographics
NPI:1922108190
Name:SHARPE, SHANNON
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SHARPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LAKE SHORE DRIVE EAST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-2331
Mailing Address - Country:US
Mailing Address - Phone:715-685-6600
Mailing Address - Fax:715-685-6601
Practice Address - Street 1:2201 LAKE SHORE DRIVE EAST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-2331
Practice Address - Country:US
Practice Address - Phone:715-685-6600
Practice Address - Fax:715-685-6601
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7182OtherLICENSE #