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General NPI Number Information
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NPI Number | 1457690513
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Entity Type | Individual
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Provider Name | SHARON GAIL FANNING PTA
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Gender | Female
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Dates
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Enumeration Date | 02/10/2013
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Last Update Date | 02/10/2013
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Provider Practice Location Address
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Address Line | 1 PRICE DR
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City | ELKTON
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State | MD
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Zip | 21921-6731
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Country | US
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Telephone | 410-398-6474
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Fax |
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Provider Business Mailing Address
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Address Line | 2412 CALF RUN DR
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City | WILMINGTON
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State | DE
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Zip | 19808-4265
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Country | US
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Telephone | 302-584-0671
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Fax | 302-994-5872
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A3866
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License Number State | MD
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