Healthcare Provider Details

I. General information

NPI: 1750769600
Provider Name (Legal Business Name): NICHOLAS ENZINNA SHARP DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 IVY DR
NORTH NEWTON KS
67117-8001
US

IV. Provider business mailing address

304 OLD COLONY CT
NORTH NEWTON KS
67117-8037
US

V. Phone/Fax

Practice location:
  • Phone: 316-836-4800
  • Fax:
Mailing address:
  • Phone: 434-942-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number11-05094
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: