Provider Demographics
NPI:1902004864
Name:WORKMAN, SHANDI SARAH (LMP)
Entity Type:Individual
Prefix:
First Name:SHANDI
Middle Name:SARAH
Last Name:WORKMAN
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 1:11014 185TH AVE E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 S STADIUM WAY
Practice Address - Street 2:STE 101
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4802
Practice Address - Country:US
Practice Address - Phone:253-383-0802
Practice Address - Fax:253-383-3603
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011398225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA120966OtherSTATE DEPT. L&I