Provider Demographics
NPI:1295579654
Name:SHARON, WALTER DALE (PT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:DALE
Last Name:SHARON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 10TH ST APT 202
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6249
Mailing Address - Country:US
Mailing Address - Phone:360-606-6928
Mailing Address - Fax:
Practice Address - Street 1:901 10TH ST APT 202
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6249
Practice Address - Country:US
Practice Address - Phone:360-606-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000060302251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics