Healthcare Provider Details

I. General information

NPI: 1669721171
Provider Name (Legal Business Name): ALAN SHARPLES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 EAST WASHINGTON STREET
BLOOMINGTON IL
61701
US

IV. Provider business mailing address

2200 EAST WASHINGTON STREET
BLOOMINGTON IL
61701
US

V. Phone/Fax

Practice location:
  • Phone: 309-662-3311
  • Fax: 309-862-4754
Mailing address:
  • Phone: 309-662-3311
  • Fax: 309-862-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.008762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: