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NPI Code Detail

MEDICARE: NICHOLAS ENZINNA SHARP DPT

MEDICARE: NICHOLAS ENZINNA SHARP DPT
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
12251G0304XGeriatric Physical Therapist11-05094KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111-05094OTHERKSKANSAS STATE BOARD OF HEALING ARTS CERTIFICATE FOR PHYSICAL THERAPY

General Provider Information

NPI Number : 1750769600
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS ENZINNA SHARP DPT
Provider Business Mailing Address
First Line : 304 OLD COLONY CT
Second Line :
City : NORTH NEWTON
State : KS
Zip : 67117-8037
Country : US
Telephone Number : 434-942-6955
Fax Number :
Provider Business Practice Location Address
First Line : 3001 IVY DR
Second Line :
City : NORTH NEWTON
State : KS
Zip : 67117-8001
Country : US
Telephone Number : 316-836-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2015
Last Update Date : 04/23/2018

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Directions to “ NICHOLAS ENZINNA SHARP DPT” Practice Location

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