Basic Information
Provider Information | |||||||||
NPI: | 1841253317 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WEYRAUCH | ||||||||
FirstName: | SANDRA | ||||||||
MiddleName: | J. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LOWNEY | ||||||||
OtherFirstName: | SANDRA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7320 216TH ST SW STE 320 | ||||||||
Address2: |   | ||||||||
City: | EDMONDS | ||||||||
State: | WA | ||||||||
PostalCode: | 980268006 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4252256867 | ||||||||
FaxNumber: | 4253322494 | ||||||||
Practice Location | |||||||||
Address1: | 15808 MILL CREEK BLVD STE 120 | ||||||||
Address2: |   | ||||||||
City: | MILL CREEK | ||||||||
State: | WA | ||||||||
PostalCode: | 980121500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4252256867 | ||||||||
FaxNumber: | 4253322494 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/07/2006 | ||||||||
LastUpdateDate: | 08/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/13/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00008278 | WA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.