Provider Demographics
NPI:1861895096
Name:KIMREY-STEWART, SHARON GAIL (PTA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:GAIL
Last Name:KIMREY-STEWART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:GAIL
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:501 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MC CUNE
Mailing Address - State:KS
Mailing Address - Zip Code:66753-8106
Mailing Address - Country:US
Mailing Address - Phone:620-238-1922
Mailing Address - Fax:
Practice Address - Street 1:501 ELM ST
Practice Address - Street 2:
Practice Address - City:MC CUNE
Practice Address - State:KS
Practice Address - Zip Code:66753-8106
Practice Address - Country:US
Practice Address - Phone:620-238-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02736225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant