Provider Demographics
NPI:1265635379
Name:RUDOLPH, SARAH KAY (LMP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KAY
Last Name:RUDOLPH
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:PO BOX 1032
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-1032
Mailing Address - Country:US
Mailing Address - Phone:951-218-2226
Mailing Address - Fax:509-891-0441
Practice Address - Street 1:14201 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2108
Practice Address - Country:US
Practice Address - Phone:509-927-4848
Practice Address - Fax:509-891-0441
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0241220OtherL & I PROVIDER NUMBER
WAMA00023000OtherSTATE LICENSE NUMBER