Provider Demographics
NPI:1265611693
Name:FRAIN CUSHING, SHARON DAWN (PT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:DAWN
Last Name:FRAIN CUSHING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 PLANTATION TRCE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3182
Mailing Address - Country:US
Mailing Address - Phone:770-664-6458
Mailing Address - Fax:770-664-6458
Practice Address - Street 1:3355 PLANTATION TRCE
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-3182
Practice Address - Country:US
Practice Address - Phone:770-664-6458
Practice Address - Fax:770-664-6458
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist