Provider Demographics
NPI:1013270750
Name:SHARP, RYANNA COLLEEN (LMT, MMP)
Entity type:Individual
Prefix:
First Name:RYANNA
Middle Name:COLLEEN
Last Name:SHARP
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7473 N TOYA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-6192
Mailing Address - Country:US
Mailing Address - Phone:928-951-5378
Mailing Address - Fax:
Practice Address - Street 1:8573 E PRINCESS DR
Practice Address - Street 2:219
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7819
Practice Address - Country:US
Practice Address - Phone:480-949-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-15361225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist