Provider Demographics
NPI:1013164995
Name:BRUFFETT, SHARON RAE (PTA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RAE
Last Name:BRUFFETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 LOSTINWOODS LANE
Mailing Address - Street 2:
Mailing Address - City:CAPE FAIR
Mailing Address - State:MO
Mailing Address - Zip Code:65624
Mailing Address - Country:US
Mailing Address - Phone:417-331-1641
Mailing Address - Fax:
Practice Address - Street 1:276 FOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:KIMBERLING CITY
Practice Address - State:MO
Practice Address - Zip Code:65686-9356
Practice Address - Country:US
Practice Address - Phone:417-739-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005029635225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant