Provider Demographics
NPI:1063850741
Name:KNUTSEN, SARA LEE (LMP)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:LEE
Last Name:KNUTSEN
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 1:1618 N 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6724
Mailing Address - Country:US
Mailing Address - Phone:619-944-5944
Mailing Address - Fax:
Practice Address - Street 1:1618 N 48TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6724
Practice Address - Country:US
Practice Address - Phone:619-944-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60359794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist