Provider Demographics
NPI:1871049676
Name:BLIXT, SARA (LMT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BLIXT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 52ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3904
Mailing Address - Country:US
Mailing Address - Phone:509-679-7744
Mailing Address - Fax:
Practice Address - Street 1:3302 FUHRMAN AVE E
Practice Address - Street 2:#110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-7115
Practice Address - Country:US
Practice Address - Phone:206-402-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60689778225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist