MEDICARE: SARAH LYNN GROSSMAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3407	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881693554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LYNN GROSSMAN PT

Provider Business Mailing Address
First Line	:	1215 LAWRENCE ST
Second Line	:	STE 101
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6554
Country	:	US
Telephone Number	:	360-385-1035
Fax Number	:	360-385-4395

Provider Business Practice Location Address
First Line	:	1215 LAWRENCE ST
Second Line	:	STE 101
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6554
Country	:	US
Telephone Number	:	360-385-1035
Fax Number	:	360-385-4395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	08/21/2009

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