Provider Demographics
NPI:1427127828
Name:SHARI A MYORAKU, PT, PC
Entity type:Organization
Organization Name:SHARI A MYORAKU, PT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MYORAKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-731-0566
Mailing Address - Street 1:333 N WILMOT RD STE 340
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2607
Mailing Address - Country:US
Mailing Address - Phone:520-731-0566
Mailing Address - Fax:520-731-0564
Practice Address - Street 1:333 N WILMOT RD STE 340
Practice Address - Street 2:SUITE 107
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2607
Practice Address - Country:US
Practice Address - Phone:520-731-0566
Practice Address - Fax:520-731-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2289261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60848OtherPTAN
AZ189804400OtherOWCP
AZZ60849OtherPTAN
AZ189804400OtherOWCP
AZZ60849OtherPTAN
AZZ60848OtherPTAN
Z60849Medicare UPIN
Z60848Medicare UPIN