Provider Demographics
NPI:1609194877
Name:PHILLIPS, SARAH I (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:I
Last Name:PHILLIPS
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 1:2839 W KENNEWICK AVE
Mailing Address - Street 2:#437
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2927
Mailing Address - Country:US
Mailing Address - Phone:509-205-8534
Mailing Address - Fax:
Practice Address - Street 1:710 GEORGE WASHINGTON WAY
Practice Address - Street 2:#N
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4254
Practice Address - Country:US
Practice Address - Phone:509-943-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00016293225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist