Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MA00003455 | WA |
N | 225700000X | Massage Therapist | MA00003455 | WA |
NPI | 1447584040 |
---|---|
Provider Name | Mrs. Sonya Marie Elhardt |
First Address | Longview, WA 98632 |
Second Address | Longview, WA 98632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2009 |
Last Update Date | 29/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L&I | 0225231 (01) |