Provider Demographics
NPI:1295966471
Name:MOHAGEN, SARA ANNE (DPT)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANNE
Last Name:MOHAGEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 N LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5510
Mailing Address - Country:US
Mailing Address - Phone:541-951-2703
Mailing Address - Fax:
Practice Address - Street 1:1803 S MERIDIAN
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7513
Practice Address - Country:US
Practice Address - Phone:253-841-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60093440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist