Provider Demographics
NPI:1295053536
Name:RONFELDT, SARAH LYNNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LYNNE
Last Name:RONFELDT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4631 WHITMAN LN SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-2201
Mailing Address - Country:US
Mailing Address - Phone:360-932-1717
Mailing Address - Fax:360-923-0404
Practice Address - Street 1:4631 WHITMAN LN SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-2201
Practice Address - Country:US
Practice Address - Phone:360-932-1717
Practice Address - Fax:360-923-0404
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60106709172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60106709OtherMASSAGE STATE LICENSE