Provider Demographics
NPI:1740632868
Name:NUMKENA, SARA (LMP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:NUMKENA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 SE MILE HILL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3511
Mailing Address - Country:US
Mailing Address - Phone:360-874-0232
Mailing Address - Fax:
Practice Address - Street 1:1800 SE MILE HILL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3511
Practice Address - Country:US
Practice Address - Phone:360-874-0232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60630844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist