Healthcare Provider Details

I. General information

NPI: 1053634378
Provider Name (Legal Business Name): SARAH HOGARTH LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5577 VANBARR PL
FREELAND WA
98249
US

IV. Provider business mailing address

3635 KINGSTON CT
CLINTON WA
98236-9224
US

V. Phone/Fax

Practice location:
  • Phone: 360-320-9491
  • Fax:
Mailing address:
  • Phone: 360-320-9491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60134525
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: