Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00002557 | WA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT00002557 | WA |
NPI | 1134223167 |
---|---|
Provider Name | Agnete H. Sorensen |
First Address | Seattle, WA 98104-2420 |
Second Address | Seattle, WA 98104-2420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 17/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
82555U | REGENCE BLUE SHIELD PIN (01) | WA |