Healthcare Provider Details

I. General information

NPI: 1154793255
Provider Name (Legal Business Name): SAHARA PIRIE L.M.P..
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16026 WALLINGFORD AVE N
SHORELINE WA
98133-5832
US

IV. Provider business mailing address

16026 WALLINGFORD AVE N
SHORELINE WA
98133-5832
US

V. Phone/Fax

Practice location:
  • Phone: 206-546-4142
  • Fax:
Mailing address:
  • Phone: 206-546-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA 00004872
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: