Provider Demographics
NPI:1700047404
Name:REHBERG, SARA (RD)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:REHBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 REITEN RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6028
Mailing Address - Country:US
Mailing Address - Phone:206-218-7282
Mailing Address - Fax:
Practice Address - Street 1:3307 3RD AVE W STE 118
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-1922
Practice Address - Country:US
Practice Address - Phone:206-286-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001926133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered