Provider Demographics
NPI:1578029294
Name:SAGE MOUNTAIN ACUPUNCTURE, PLLC
Entity Type:Organization
Organization Name:SAGE MOUNTAIN ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, EAMP
Authorized Official - Phone:206-384-8736
Mailing Address - Street 1:3410 NE 80TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4840
Mailing Address - Country:US
Mailing Address - Phone:206-384-8736
Mailing Address - Fax:
Practice Address - Street 1:14090 FRYELANDS BLVD SE STE 249
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2693
Practice Address - Country:US
Practice Address - Phone:206-384-8736
Practice Address - Fax:360-805-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty