Healthcare Provider Details

I. General information

NPI: 1811062532
Provider Name (Legal Business Name): NICOLE ANDERSON SHARP MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WOODLAND PARK CARE CENTER 3855 S 700 E
MURREY UT
84106
US

IV. Provider business mailing address

499N 20000 #35
BOUTIFUL UT
84010
US

V. Phone/Fax

Practice location:
  • Phone: 801-506-1185
  • Fax:
Mailing address:
  • Phone: 801-864-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number331421-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: