Provider Demographics
NPI:1194002899
Name:SODERSTROM, BEATRICE E (LMP)
Entity Type:Individual
Prefix:MS
First Name:BEATRICE
Middle Name:E
Last Name:SODERSTROM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S 12TH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3141
Mailing Address - Country:US
Mailing Address - Phone:509-910-1844
Mailing Address - Fax:
Practice Address - Street 1:307 S 12TH AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3100
Practice Address - Country:US
Practice Address - Phone:509-910-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA 00006575OtherMASSAGE