Provider Demographics
NPI:1235193749
Name:FRY, SARAH J (LMP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:FRY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:VILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:3912 10TH ST SE
Practice Address - Street 2:SUITE 101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2188
Practice Address - Country:US
Practice Address - Phone:253-848-4700
Practice Address - Fax:253-848-2284
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017811225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2351VIOtherREGENCE BLUE SHIELD
WA8934966OtherCRIME VICTIMS
WA170745OtherDEPT OF LABOR & INDUSTRIE