Provider Demographics
NPI:1154587608
Name:TUBBS, SARAH JEAN (LAC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:TUBBS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 19TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3005
Mailing Address - Country:US
Mailing Address - Phone:360-402-8799
Mailing Address - Fax:
Practice Address - Street 1:524 JEFFERSON ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1466
Practice Address - Country:US
Practice Address - Phone:360-705-0799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA14545172M00000X
NC995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No172M00000XOther Service ProvidersMechanotherapist