Provider Demographics
NPI:1720351380
Name:SHARP, CHRISTINE BETH (MMT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:BETH
Last Name:SHARP
Suffix:
Gender:F
Credentials:MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 GREENWOOD AVE SE
Mailing Address - Street 2:STE 200
Mailing Address - City:EAST GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2901
Mailing Address - Country:US
Mailing Address - Phone:616-318-0648
Mailing Address - Fax:
Practice Address - Street 1:535 GREENWOOD AVE SE
Practice Address - Street 2:STE 200
Practice Address - City:EAST GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2901
Practice Address - Country:US
Practice Address - Phone:616-318-0648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist