Healthcare Provider Details

I. General information

NPI: 1619087178
Provider Name (Legal Business Name): SHARON WISNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22757 72ND AVE S STE 102
KENT WA
98032-2459
US

IV. Provider business mailing address

20223 9TH AVE S
DES MOINES WA
98198-3432
US

V. Phone/Fax

Practice location:
  • Phone: 253-872-4118
  • Fax:
Mailing address:
  • Phone: 206-878-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: