Provider Demographics
NPI:1528235637
Name:WHITE, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:ARIZONA HWY 264
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505
Mailing Address - Country:US
Mailing Address - Phone:928-755-4640
Mailing Address - Fax:
Practice Address - Street 1:ARIZONA HWY 264
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist