Provider Demographics
NPI:1003960683
Name:KERRICK, SARA (MS, PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KERRICK
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:402 15TH AVE SE
Mailing Address - Street 2:#100
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3709
Mailing Address - Country:US
Mailing Address - Phone:253-607-5200
Mailing Address - Fax:253-697-5145
Practice Address - Street 1:402 15TH AVE SE
Practice Address - Street 2:#100
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3709
Practice Address - Country:US
Practice Address - Phone:253-607-5200
Practice Address - Fax:253-697-5145
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist