Provider Demographics
NPI:1710797162
Name:REYNOLDS, SHARON (CMT, NMT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 PLACER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2158
Mailing Address - Country:US
Mailing Address - Phone:209-660-1414
Mailing Address - Fax:
Practice Address - Street 1:177 PLACER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2158
Practice Address - Country:US
Practice Address - Phone:209-660-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95904225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist