Provider Demographics
NPI:1043366859
Name:KORTAN, SARA (LMP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:KORTAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-5366
Mailing Address - Country:US
Mailing Address - Phone:509-669-8118
Mailing Address - Fax:
Practice Address - Street 1:247 4TH ST SE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-5366
Practice Address - Country:US
Practice Address - Phone:509-669-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00015689225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00015689OtherLMP NUMBER
WA125723OtherAMTA
WA303208-00OtherNCBTMB
WA0152532OtherL&I PROVIDER NUMBER