Provider Demographics
NPI:1104047042
Name:NOLAN, SHARON R (PTA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:R
Last Name:NOLAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 BEHRWALD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4815
Mailing Address - Country:US
Mailing Address - Phone:216-398-5328
Mailing Address - Fax:
Practice Address - Street 1:4360 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286
Practice Address - Country:US
Practice Address - Phone:330-659-6166
Practice Address - Fax:330-659-2944
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA00104225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant