Basic Information
Provider Information
NPI: 1003189879
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REID
FirstName: SHARON
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 350 NEW FIDELITY CT
Address2:  
City: GARNER
State: NC
PostalCode: 275292665
CountryCode: US
TelephoneNumber: 9192582714
FaxNumber: 4106484878
Practice Location
Address1: 844 WASHINGTON RD
Address2: SUITE 101
City: WESTMINSTER
State: MD
PostalCode: 211576664
CountryCode: US
TelephoneNumber: 4108765600
FaxNumber: 4108761623
Other Information
ProviderEnumerationDate: 02/09/2012
LastUpdateDate: 03/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X14623MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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