Provider Demographics
NPI:1699937128
Name:BAXTER, SHARON LOU (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LOU
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:637 S STATE ROAD 135
Mailing Address - Street 2:STE C
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1443
Mailing Address - Country:US
Mailing Address - Phone:317-865-1110
Mailing Address - Fax:317-865-0221
Practice Address - Street 1:637 S STATE ROAD 135
Practice Address - Street 2:STE C
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1443
Practice Address - Country:US
Practice Address - Phone:317-865-1110
Practice Address - Fax:317-865-0221
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06000236A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant