Provider Demographics
NPI:1285685057
Name:AGASSIZ, SARA JOYCE (PT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JOYCE
Last Name:AGASSIZ
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 DUVALL AVE NE
Mailing Address - Street 2:STE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4675
Mailing Address - Country:US
Mailing Address - Phone:425-235-9505
Mailing Address - Fax:425-226-7334
Practice Address - Street 1:451 DUVALL AVE NE
Practice Address - Street 2:STE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4675
Practice Address - Country:US
Practice Address - Phone:425-235-9505
Practice Address - Fax:425-226-7334
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist