Healthcare Provider Details

I. General information

NPI: 1952760175
Provider Name (Legal Business Name): SHARON WORDEN MHS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 MAIN ST APT 812
TACOMA WA
98407-3166
US

IV. Provider business mailing address

5005 MAIN ST APT 812
TACOMA WA
98407-3166
US

V. Phone/Fax

Practice location:
  • Phone: 317-626-0007
  • Fax:
Mailing address:
  • Phone: 317-626-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number00002944
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: