Provider Demographics
NPI:1518273291
Name:JUSTICE, SHARON ADELE (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ADELE
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:THACKER
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-1671
Mailing Address - Country:US
Mailing Address - Phone:540-958-0379
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 142
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-0142
Practice Address - Country:US
Practice Address - Phone:540-958-0379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2025-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
COPTL0010685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist