Provider Demographics
NPI:1083293211
Name:CORZANO, SONJA HORTENCE (LMT)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:HORTENCE
Last Name:CORZANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 SE 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1947
Mailing Address - Country:US
Mailing Address - Phone:929-379-7213
Mailing Address - Fax:
Practice Address - Street 1:4415 NE SANDY BLVD STE 207
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1400
Practice Address - Country:US
Practice Address - Phone:929-379-7213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23834225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist