Healthcare Provider Details

I. General information

NPI: 1346416294
Provider Name (Legal Business Name): SHARYN IRENE MOXLEY MS,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 HALEY STREET
MELBOURNE AR
72556
US

IV. Provider business mailing address

1013 HALEY ST PO BOX 739
MELBOURNE AR
72556
US

V. Phone/Fax

Practice location:
  • Phone: 870-368-7955
  • Fax: 870-368-4920
Mailing address:
  • Phone: 870-368-7955
  • Fax: 870-368-4920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 1776
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: