Basic Information
| Provider Information | |||||||||
| NPI: | 1427127828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHARI A MYORAKU, PT, PC | ||||||||
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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: | SUITE 107 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857112607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207310566 | ||||||||
| FaxNumber: | 5207310564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 06/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | MYORAKU | ||||||||
| AuthorizedOfficialFirstName: | SHARI | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5207310566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 2289 | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | Z60848 | 01 | AZ | PTAN | OTHER | 189804400 | 01 | AZ | OWCP | OTHER | Z60849 | 01 | AZ | PTAN | OTHER |