Provider Demographics
NPI:1013350537
Name:KURTH, SADIE MAE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SADIE
Middle Name:MAE
Last Name:KURTH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:SADIE
Other - Middle Name:MAE
Other - Last Name:VICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7007 BURDEN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-9185
Mailing Address - Country:US
Mailing Address - Phone:509-543-1123
Mailing Address - Fax:
Practice Address - Street 1:7007 BURDEN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9185
Practice Address - Country:US
Practice Address - Phone:509-543-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60215446172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist