Provider Demographics
NPI:1346435831
Name:PATTON, SHARON LOUISE (PTA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LOUISE
Last Name:PATTON
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 1:14053 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-4738
Mailing Address - Country:US
Mailing Address - Phone:800-875-8999
Mailing Address - Fax:561-417-7443
Practice Address - Street 1:14053 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-4738
Practice Address - Country:US
Practice Address - Phone:800-875-8999
Practice Address - Fax:561-417-7443
Is Sole Proprietor?:No
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117519225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant