Provider Demographics
NPI:1598210577
Name:NICHOLS, SARA ASHLEY (DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ASHLEY
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 S DAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2362
Mailing Address - Country:US
Mailing Address - Phone:408-712-1664
Mailing Address - Fax:
Practice Address - Street 1:3807 CARR PL N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8125
Practice Address - Country:US
Practice Address - Phone:408-712-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60689627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist