Healthcare Provider Details

I. General information

NPI: 1124382619
Provider Name (Legal Business Name): RACHEL LEANNE SHARPE ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 261954
CONWAY SC
29528-6054
US

IV. Provider business mailing address

PO BOX 261954
CONWAY SC
29528-6054
US

V. Phone/Fax

Practice location:
  • Phone: 843-349-2887
  • Fax: 843-333-7507
Mailing address:
  • Phone: 843-349-2887
  • Fax: 843-333-7507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1963
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: