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General NPI Number Information
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NPI Number | 1316866619
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Entity Type | Organization
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Legal Business Name | SAGEBRUSH THERAPY PARTNERS
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 6434 JEFFREY CT SE
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City | LACEY
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State | WA
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Zip | 98513-6531
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Country | US
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Telephone | 720-422-0262
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Fax |
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Provider Business Mailing Address
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Address Line | 6434 JEFFREY CT SE
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City | LACEY
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State | WA
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Zip | 98513-6531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMIE LARAQUE-TWO ELK
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Credential | PT,DPT,GCS,MPH,MBA
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Telephone | 720-422-0262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State |
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