Provider Demographics
NPI:1215652888
Name:GASTON, SHARI LYNN (PT)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:LYNN
Last Name:GASTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:LYNN
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1048 BROAD AX LN
Mailing Address - Street 2:
Mailing Address - City:SMITHS CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48074-3232
Mailing Address - Country:US
Mailing Address - Phone:417-396-1992
Mailing Address - Fax:
Practice Address - Street 1:1048 BROAD AX LN
Practice Address - Street 2:
Practice Address - City:SMITHS CREEK
Practice Address - State:MI
Practice Address - Zip Code:48074-3232
Practice Address - Country:US
Practice Address - Phone:417-396-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist