Provider Demographics
NPI:1568573723
Name:SANDERHOFF, AUDRA K (LMP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:K
Last Name:SANDERHOFF
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 N 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8801
Mailing Address - Country:US
Mailing Address - Phone:206-200-2888
Mailing Address - Fax:206-706-4994
Practice Address - Street 1:760 N 34TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8801
Practice Address - Country:US
Practice Address - Phone:206-200-2888
Practice Address - Fax:206-706-4994
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0209301OtherL & I PROVIDER #