Provider Demographics
NPI:1174739338
Name:JOHANSEN, SHARON KAY (ATC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3637
Mailing Address - Country:US
Mailing Address - Phone:804-512-5546
Mailing Address - Fax:
Practice Address - Street 1:9000 STONY POINT PKWY
Practice Address - Street 2:PHYSICAL THERAPY DEPT.
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1900
Practice Address - Country:US
Practice Address - Phone:804-237-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260001342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer