Provider Demographics
NPI:1225348329
Name:KURTZ, SHERRA BREANNE (LMP)
Entity Type:Individual
Prefix:
First Name:SHERRA
Middle Name:BREANNE
Last Name:KURTZ
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 1:14322 72ND ST E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-8281
Mailing Address - Country:US
Mailing Address - Phone:253-579-8600
Mailing Address - Fax:
Practice Address - Street 1:13028 INTERURBAN AVE S STE 106
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3340
Practice Address - Country:US
Practice Address - Phone:206-957-7950
Practice Address - Fax:206-975-7952
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60112201225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist