Provider Demographics
NPI:1538624283
Name:JUDGE, SARAH (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JUDGE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18925 E VALLEYWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-9698
Mailing Address - Country:US
Mailing Address - Phone:208-251-7881
Mailing Address - Fax:
Practice Address - Street 1:1104 N 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3217
Practice Address - Country:US
Practice Address - Phone:208-292-4873
Practice Address - Fax:208-292-4875
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
IDMASG-486225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist