Provider Demographics
NPI:1770006348
Name:LONGANECKER, SARAH ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:LONGANECKER
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 1:18920 25TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6938
Mailing Address - Country:US
Mailing Address - Phone:425-301-3877
Mailing Address - Fax:
Practice Address - Street 1:1132 164TH ST SW STE A
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8167
Practice Address - Country:US
Practice Address - Phone:425-409-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60767347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60767347OtherMASSAGE THERAPY LICENSE