Basic Information
| Provider Information | |||||||||
| NPI: | 1003002866 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYORAKU | ||||||||
| FirstName: | SHARI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2289 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Z60849 | 01 | AZ | MEDICARE PROVIDER | OTHER |