Provider Demographics
NPI:1871137992
Name:SHARPE, SUSAN W (PTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:SHARPE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 LONGHERRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-6111
Mailing Address - Country:US
Mailing Address - Phone:713-702-2956
Mailing Address - Fax:
Practice Address - Street 1:721 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4239
Practice Address - Country:US
Practice Address - Phone:979-848-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2055597208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation