Provider Demographics
NPI:1578760146
Name:SHAPIRO, SARA (MPH, PT)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MPH, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 E LAURIDSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6640
Mailing Address - Country:US
Mailing Address - Phone:360-417-0557
Mailing Address - Fax:360-452-5117
Practice Address - Street 1:1116 E LAURIDSEN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6640
Practice Address - Country:US
Practice Address - Phone:360-417-0557
Practice Address - Fax:360-452-5117
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002309225100000X
CA10354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist