Provider Demographics
NPI:1376701466
Name:WILSON, SARAH AMANDA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:AMANDA
Last Name:WILSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 HARMAN WAY S SPC 61
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-9541
Mailing Address - Country:US
Mailing Address - Phone:253-797-7031
Mailing Address - Fax:
Practice Address - Street 1:836 HARMAN WAY S SPC 61
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9541
Practice Address - Country:US
Practice Address - Phone:253-797-7031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant