Healthcare Provider Details

I. General information

NPI: 1154553204
Provider Name (Legal Business Name): SARA ELIZABETH HEIBERG CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4139
US

IV. Provider business mailing address

723 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4139
US

V. Phone/Fax

Practice location:
  • Phone: 253-383-4447
  • Fax:
Mailing address:
  • Phone: 253-383-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: