Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00018219 | WA |
NPI | 1023173465 |
---|---|
Provider Name | Mrs. Sara Jean Denherder |
First Address | Renton, WA 98058-9539 |
Second Address | Renton, WA 98058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 08/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0175957 | DEPARTMENT OF L&I (01) | WA |