Basic Information
Provider Information
NPI: 1003002866
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MYORAKU
FirstName: SHARI
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 333 N WILMOT RD STE 340
Address2:  
City: TUCSON
State: AZ
PostalCode: 857112607
CountryCode: US
TelephoneNumber: 5207310566
FaxNumber: 5207310564
Practice Location
Address1: 333 N WILMOT RD STE 340
Address2:  
City: TUCSON
State: AZ
PostalCode: 857112607
CountryCode: US
TelephoneNumber: 5207310566
FaxNumber: 5207310564
Other Information
ProviderEnumerationDate: 09/14/2007
LastUpdateDate: 07/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X2289AZY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
Z6084901AZMEDICARE PROVIDEROTHER


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