Provider Demographics
NPI:1427244375
Name:SMITH, SHARON LEIGH (PT)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:LEIGH
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:BOX 1191
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435
Mailing Address - Country:US
Mailing Address - Phone:307-754-2864
Mailing Address - Fax:307-754-9829
Practice Address - Street 1:558 E 2ND ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2001
Practice Address - Country:US
Practice Address - Phone:307-754-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT314430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1770688871Medicaid