Provider Demographics
NPI:1750769600
Name:SHARP, NICHOLAS ENZINNA (DPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ENZINNA
Last Name:SHARP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 OLD COLONY CT
Mailing Address - Street 2:
Mailing Address - City:NORTH NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67117-8037
Mailing Address - Country:US
Mailing Address - Phone:434-942-6955
Mailing Address - Fax:
Practice Address - Street 1:3001 IVY DR
Practice Address - Street 2:
Practice Address - City:NORTH NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67117-8001
Practice Address - Country:US
Practice Address - Phone:316-836-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-050942251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-05094OtherKANSAS STATE BOARD OF HEALING ARTS CERTIFICATE FOR PHYSICAL THERAPY