Provider Demographics
NPI:1952737025
Name:FUNK, SARA ROCHELLE (LMP)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:ROCHELLE
Last Name:FUNK
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 1:14313 NE 20TH AVE
Mailing Address - Street 2:SUITE A112
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1487
Mailing Address - Country:US
Mailing Address - Phone:360-574-9440
Mailing Address - Fax:360-574-9288
Practice Address - Street 1:14313 NE 20TH AVE
Practice Address - Street 2:SUITE A112
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-1487
Practice Address - Country:US
Practice Address - Phone:360-574-9440
Practice Address - Fax:360-574-9288
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60384530225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist