Provider Demographics
NPI:1821207697
Name:CYR, SANDRA JEAN (LMP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:CYR
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NE 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5020
Mailing Address - Country:US
Mailing Address - Phone:360-944-6692
Mailing Address - Fax:360-944-7732
Practice Address - Street 1:400 E EVERGREEN BLVD STE 106A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3385
Practice Address - Country:US
Practice Address - Phone:360-521-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018303225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist