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General NPI Number Information
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NPI Number | 1023173465
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Entity Type | Individual
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Provider Name | SARA JEAN DENHERDER LMP
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Gender | Female
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 17070 - 140TH AVE SE
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City | RENTON
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State | WA
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Zip | 98058
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Country | US
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Telephone | 206-228-6296
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Fax | 425-277-2931
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Provider Business Mailing Address
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Address Line | 18635 - 175 AVENUE SE
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City | RENTON
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State | WA
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Zip | 98058-9539
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Country | US
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Telephone | 206-228-6296
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Fax | 425-277-2931
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00018219
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License Number State | WA
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