Healthcare Provider Details

I. General information

NPI: 1689866022
Provider Name (Legal Business Name): SHARIN M GANNON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S BISSELL RD (AURORA MANOR-THERAPY DEPT.)
AURORA OH
44202-9170
US

IV. Provider business mailing address

10312 BELLEAU DR
TWINSBURG OH
44087-1149
US

V. Phone/Fax

Practice location:
  • Phone: 330-562-5000
  • Fax:
Mailing address:
  • Phone: 330-405-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5525
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: