Provider Demographics
NPI:1871586198
Name:HERTZIG, SADA K (PT)
Entity type:Individual
Prefix:
First Name:SADA
Middle Name:K
Last Name:HERTZIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SADA
Other - Middle Name:K
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-0480
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:32030 23RD AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6031
Practice Address - Country:US
Practice Address - Phone:253-946-4852
Practice Address - Fax:253-946-4862
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA650024233OtherR/R MED KING COUNTY
WA5840HEOtherREGENCE B/S
WA650024237OtherR/R MED PIERCE COUNTY
WA162111OtherDEPT OF L&I
WA8937359OtherCRIME VICTIMS
WAAB32498Medicare ID - Type UnspecifiedKING COUNTY
WA5840HEOtherREGENCE B/S