Healthcare Provider Details

I. General information

NPI: 1902731623
Provider Name (Legal Business Name): TAEGHAN RENEE WARD SHARPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W BASELINE RD STE 140
MESA AZ
85202-5821
US

IV. Provider business mailing address

2526 CARLTON DR
LAWRENCE KS
66046-5544
US

V. Phone/Fax

Practice location:
  • Phone: 638-716-7864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP060379T
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1108215
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: