Provider Demographics
NPI:1326547845
Name:SADLER, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:SADLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24030 132ND AVE SE UNIT A
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5109
Mailing Address - Country:US
Mailing Address - Phone:253-630-6614
Mailing Address - Fax:253-630-6624
Practice Address - Street 1:24030 132ND AVE SE UNIT A
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5109
Practice Address - Country:US
Practice Address - Phone:253-630-6614
Practice Address - Fax:253-630-6624
Is Sole Proprietor?:No
Enumeration Date:2018-02-10
Last Update Date:2019-06-20
Deactivation Date:2019-02-19
Deactivation Code:
Reactivation Date:2019-06-20
Provider Licenses
StateLicense IDTaxonomies
WAMA60656972225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA451630389Medicaid