Provider Demographics
NPI:1285069625
Name:JAHNKE, SARA LUCILLE (PTA)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LUCILLE
Last Name:JAHNKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3752 MONTLAKE BLVD
Mailing Address - Street 2:BOX 354060
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0010
Mailing Address - Country:US
Mailing Address - Phone:206-598-7593
Mailing Address - Fax:206-598-3140
Practice Address - Street 1:3752 MONTLAKE BLVD
Practice Address - Street 2:BOX 354060
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0010
Practice Address - Country:US
Practice Address - Phone:206-598-7593
Practice Address - Fax:206-598-3140
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60267709225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant