Provider Demographics
NPI:1245715051
Name:REIFSCHNEIDER, SARA KRISTINE
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:KRISTINE
Last Name:REIFSCHNEIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 E WILDFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-7377
Mailing Address - Country:US
Mailing Address - Phone:253-777-5176
Mailing Address - Fax:
Practice Address - Street 1:65 E WILDFLOWER LN
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-7377
Practice Address - Country:US
Practice Address - Phone:253-777-5176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60853477225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60853477OtherLMT