Provider Demographics
NPI:1144897091
Name:PURKIS, SHARON D (PT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:D
Last Name:PURKIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13411 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9153
Mailing Address - Country:US
Mailing Address - Phone:123-172-6071
Mailing Address - Fax:
Practice Address - Street 1:ROOSEVELT PARK NURSING
Practice Address - Street 2:1300 W BROADWAY AVE
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441
Practice Address - Country:US
Practice Address - Phone:231-755-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist