Provider Demographics
NPI:1376708453
Name:HARKNESS, SARA LYNN (LMT)
Entity type:Individual
Prefix:MISS
First Name:SARA
Middle Name:LYNN
Last Name:HARKNESS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:MASYCZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADAC
Mailing Address - Street 1:1925 SW PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2051
Mailing Address - Country:US
Mailing Address - Phone:951-231-5683
Mailing Address - Fax:
Practice Address - Street 1:18676 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8435
Practice Address - Country:US
Practice Address - Phone:971-404-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28286225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist