Provider Demographics
NPI:1023173465
Name:DENHERDER, SARA JEAN (LMP)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JEAN
Last Name:DENHERDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18635 - 175 AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9539
Mailing Address - Country:US
Mailing Address - Phone:206-228-6296
Mailing Address - Fax:425-277-2931
Practice Address - Street 1:17070 - 140TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058
Practice Address - Country:US
Practice Address - Phone:206-228-6296
Practice Address - Fax:425-277-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0175957OtherDEPARTMENT OF L&I