Provider Demographics
NPI:1497371454
Name:SORTMAN, TORI
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:SORTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:SORTMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:436 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7018
Mailing Address - Country:US
Mailing Address - Phone:907-376-8020
Mailing Address - Fax:907-376-8017
Practice Address - Street 1:12812 OLD GLENN HWY STE A8
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7003
Practice Address - Country:US
Practice Address - Phone:907-696-8020
Practice Address - Fax:907-696-8021
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK124758225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist