Provider Demographics
NPI:1881693554
Name:GROSSMAN, SARAH LYNN (PT)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LAWRENCE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6554
Mailing Address - Country:US
Mailing Address - Phone:360-385-1035
Mailing Address - Fax:360-385-4395
Practice Address - Street 1:1215 LAWRENCE ST
Practice Address - Street 2:STE 101
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6554
Practice Address - Country:US
Practice Address - Phone:360-385-1035
Practice Address - Fax:360-385-4395
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8416646Medicaid
WA8416646Medicaid