Provider Demographics
NPI:1417554551
Name:SUGARMAN, ELIZABETH ARIN (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ARIN
Last Name:SUGARMAN
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 1:1132 DILLEY RD
Mailing Address - Street 2:
Mailing Address - City:TIETON
Mailing Address - State:WA
Mailing Address - Zip Code:98947-9719
Mailing Address - Country:US
Mailing Address - Phone:509-480-1839
Mailing Address - Fax:
Practice Address - Street 1:1132 DILLEY RD
Practice Address - Street 2:
Practice Address - City:TIETON
Practice Address - State:WA
Practice Address - Zip Code:98947-9719
Practice Address - Country:US
Practice Address - Phone:509-480-1839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61039759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant