Provider Demographics
NPI:1548794779
Name:GREENHOUSE, SARA (LMT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:GREENHOUSE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 SE GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3455
Mailing Address - Country:US
Mailing Address - Phone:323-915-9976
Mailing Address - Fax:
Practice Address - Street 1:1417 N SHAVER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1060
Practice Address - Country:US
Practice Address - Phone:971-279-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22707172M00000X
CA5098172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist