MEDICARE: MISS SHARON LEE KAIN 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	PTA1819	FL

General Provider Information

NPI Number	:	1730363722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHARON LEE KAIN PTA

Provider Business Mailing Address
First Line	:	452 CLEARWATER LAKE DR
Second Line	:
City	:	POLK CITY
State	:	FL
Zip	:	33868-9085
Country	:	US
Telephone Number	:	352-615-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	452 CLEARWATER LAKE DR
Second Line	:
City	:	POLK CITY
State	:	FL
Zip	:	33868-9085
Country	:	US
Telephone Number	:	352-615-3404
Fax Number	:

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

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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