Provider Demographics
NPI:1144918863
Name:FUNG-CORRILL, SHARON (PTA)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:FUNG-CORRILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6736 JENNYANN WAY
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8636
Mailing Address - Country:US
Mailing Address - Phone:740-584-5411
Mailing Address - Fax:
Practice Address - Street 1:5323 HENDRON RD
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-1055
Practice Address - Country:US
Practice Address - Phone:614-836-2349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH09315926183700000X
OHPTA013013225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No183700000XPharmacy Service ProvidersPharmacy Technician