Provider Demographics
NPI:1730363722
Name:KAIN, SHARON LEE (PTA)
Entity type:Individual
Prefix:MISS
First Name:SHARON
Middle Name:LEE
Last Name:KAIN
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 1:452 CLEARWATER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33868-9085
Mailing Address - Country:US
Mailing Address - Phone:352-615-3404
Mailing Address - Fax:
Practice Address - Street 1:452 CLEARWATER LAKE DR
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:FL
Practice Address - Zip Code:33868-9085
Practice Address - Country:US
Practice Address - Phone:352-615-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1819225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant