Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2289 | AZ |
NPI | 1003002866 |
---|---|
Provider Name | Shari A Myoraku |
First Address | Tucson, AZ 85711-2607 |
Second Address | Tucson, AZ 85711-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2007 |
Last Update Date | 25/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S98401 | (02) | |
Z60849 | MEDICARE PROVIDER (01) | AZ |