Provider Demographics
NPI:1063532356
Name:THOMAS, SHARON A (LMT, NCMMT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMT, NCMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 SARATOGA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1904
Mailing Address - Country:US
Mailing Address - Phone:719-630-3199
Mailing Address - Fax:719-227-8502
Practice Address - Street 1:1465 KELLY JOHNSON BLVD STE 320
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3947
Practice Address - Country:US
Practice Address - Phone:719-630-3199
Practice Address - Fax:719-227-8502
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO130572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist