MEDICARE: MS. SARA ROCHELLE FUNK LMP

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	225700000X	Massage Therapist	MA60384530	WA

General Provider Information

NPI Number	:	1952737025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA ROCHELLE FUNK LMP

Provider Business Mailing Address
First Line	:	14313 NE 20TH AVE
Second Line	:	SUITE A112
City	:	VANCOUVER
State	:	WA
Zip	:	98686-1487
Country	:	US
Telephone Number	:	360-574-9440
Fax Number	:	360-574-9288

Provider Business Practice Location Address
First Line	:	14313 NE 20TH AVE
Second Line	:	SUITE A112
City	:	VANCOUVER
State	:	WA
Zip	:	98686-1487
Country	:	US
Telephone Number	:	360-574-9440
Fax Number	:	360-574-9288

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

Provider Enumeration Date	:	09/20/2013
Last Update Date	:	09/20/2013

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