Provider Demographics
NPI:1174097414
Name:SHARON, MATTHEW (PTA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SHARON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5170
Mailing Address - Country:US
Mailing Address - Phone:865-661-7243
Mailing Address - Fax:
Practice Address - Street 1:5321 BEVERLY PARK CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-9253
Practice Address - Country:US
Practice Address - Phone:865-661-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4951225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty