Provider Demographics
NPI:1982000907
Name:ALLEN, SARA MICHELE (LMP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MICHELE
Last Name:ALLEN
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 1:7814 266TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7308
Mailing Address - Country:US
Mailing Address - Phone:931-217-4079
Mailing Address - Fax:
Practice Address - Street 1:22811 MERIDIAN AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-9275
Practice Address - Country:US
Practice Address - Phone:253-271-9351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60484352225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist