Provider Demographics
NPI:1093284630
Name:SOTO, ELIZABETH (LMT, CLT, CPMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:LMT, CLT, CPMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-1971
Mailing Address - Country:US
Mailing Address - Phone:610-417-4606
Mailing Address - Fax:
Practice Address - Street 1:2505 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-1971
Practice Address - Country:US
Practice Address - Phone:610-417-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG011931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist