Provider Demographics
NPI:1003974650
Name:GRACE, SONYA C (LMP)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:C
Last Name:GRACE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:C
Other - Last Name:OLSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7711 NE 175TH ST.
Mailing Address - Street 2:A108
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028
Mailing Address - Country:US
Mailing Address - Phone:206-729-7429
Mailing Address - Fax:206-826-0455
Practice Address - Street 1:7800 NE BOTHELL WAY
Practice Address - Street 2:#155
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028
Practice Address - Country:US
Practice Address - Phone:206-729-7429
Practice Address - Fax:206-826-0455
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA12347225700000X
WAMA00012347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist