Provider Demographics
NPI:1669714580
Name:RHODES, SHARON LISA (PTA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LISA
Last Name:RHODES
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 1:36181 E LAKE RD
Mailing Address - Street 2:266
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3142
Mailing Address - Country:US
Mailing Address - Phone:727-452-8921
Mailing Address - Fax:
Practice Address - Street 1:36181 E LAKE RD
Practice Address - Street 2:266
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-3142
Practice Address - Country:US
Practice Address - Phone:727-452-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE005303L225200000X
FLPTA 19932225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant