Provider Demographics
NPI:1164630620
Name:BITTNER, SANDRA T (LMP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:T
Last Name:BITTNER
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 1:30821 SE 392ND ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-7770
Mailing Address - Country:US
Mailing Address - Phone:253-709-2570
Mailing Address - Fax:360-829-1836
Practice Address - Street 1:700 MAIN ST P
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321
Practice Address - Country:US
Practice Address - Phone:253-709-2570
Practice Address - Fax:360-829-1836
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA53064007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist