Provider Demographics
NPI:1841253317
Name:WEYRAUCH, SANDRA J (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:WEYRAUCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:LOWNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7320 216TH ST SW STE 320
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8006
Mailing Address - Country:US
Mailing Address - Phone:425-673-3900
Mailing Address - Fax:425-673-3910
Practice Address - Street 1:15808 MILL CREEK BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1500
Practice Address - Country:US
Practice Address - Phone:425-225-6867
Practice Address - Fax:425-332-2494
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0223313OtherL & I
WAG8867476OtherMEDICARE NON-KING CO.