Basic Information
Provider Information
NPI: 1174628630
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HANNA
FirstName: SARAH
MiddleName: J.
NamePrefix:  
NameSuffix:  
Credential: MPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 24366
Address2: M/S 359107
City: SEATTLE
State: WA
PostalCode: 981240366
CountryCode: US
TelephoneNumber: 2065980502
FaxNumber: 2065980516
Practice Location
Address1: 11695 NE 4TH ST
Address2:  
City: BELLEVUE
State: WA
PostalCode: 980045268
CountryCode: US
TelephoneNumber: 4256371855
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/13/2006
LastUpdateDate: 07/23/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/23/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT00007911WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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