Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT60797104 | WA |
Y | 213ES0000X | Sports Medicine | PT60797104 | WA |
NPI | 1134637176 |
---|---|
Provider Name | Sophie Warshaw |
First Address | Tacoma, WA 98409-2314 |
Second Address | Tacoma, WA 98409-2314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 11/01/2018 |