Provider Demographics
NPI:1811062532
Name:SHARP, NICOLE ANDERSON (MS PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANDERSON
Last Name:SHARP
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:499N 20000
Mailing Address - Street 2:#35
Mailing Address - City:BOUTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010
Mailing Address - Country:US
Mailing Address - Phone:801-864-7007
Mailing Address - Fax:
Practice Address - Street 1:WOODLAND PARK CARE CENTER
Practice Address - Street 2:3855 S 700 E
Practice Address - City:MURREY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-506-1185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT331421-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist