Provider Demographics
NPI:1033192752
Name:RUSSELL, SARAH MARGARET (PT)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARGARET
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:MARGARET
Other - Last Name:CLOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:414 S UNIVERSITY RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5555
Mailing Address - Country:US
Mailing Address - Phone:509-924-4650
Mailing Address - Fax:509-228-0851
Practice Address - Street 1:414 S UNIVERSITY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5555
Practice Address - Country:US
Practice Address - Phone:509-924-4650
Practice Address - Fax:509-228-0851
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5454225100000X
IDPT 1214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0191736OtherSTAF WA L I
WA7080112Medicaid
WA7080112Medicaid