MEDICARE: SHARON HONICK RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT685	OK

General Provider Information

NPI Number	:	1093836512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON HONICK RPT

Provider Business Mailing Address
First Line	:	9223 W EARTH RD
Second Line	:
City	:	BRAMAN
State	:	OK
Zip	:	74632-9137
Country	:	US
Telephone Number	:	580-362-5351
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 E PROSPECT AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1746
Country	:	US
Telephone Number	:	580-765-8155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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