MEDICARE: MS. SHARON LISA RHODES PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	TE005303L	PA
2	225200000X	Physical Therapy Assistant	PTA 19932	FL

General Provider Information

NPI Number	:	1669714580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON LISA RHODES PTA

Provider Business Mailing Address
First Line	:	36181 E LAKE RD
Second Line	:	266
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3142
Country	:	US
Telephone Number	:	727-452-8921
Fax Number	:

Provider Business Practice Location Address
First Line	:	36181 E LAKE RD
Second Line	:	266
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3142
Country	:	US
Telephone Number	:	727-452-8921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	03/18/2013

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