Provider Demographics
NPI:1700275328
Name:SHARP, MAIRAN GAPPMAYER (LMT)
Entity Type:Individual
Prefix:
First Name:MAIRAN
Middle Name:GAPPMAYER
Last Name:SHARP
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 W 10480 N
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-9292
Mailing Address - Country:US
Mailing Address - Phone:801-228-7634
Mailing Address - Fax:
Practice Address - Street 1:12 W 100 N
Practice Address - Street 2:202C
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1611
Practice Address - Country:US
Practice Address - Phone:801-906-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT78755064701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist