Provider Demographics
NPI:1508114364
Name:SORAN, COURTNEY ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:SORAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:ELIZABETH
Other - Last Name:ATWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:1301 HIGHLANDS PARKWAY NORTH
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-752-7112
Practice Address - Fax:253-752-7265
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160291266225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant