Provider Demographics
NPI:1609958701
Name:SODORFF, STEVEN A (RPT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:A
Last Name:SODORFF
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1735
Mailing Address - Country:US
Mailing Address - Phone:208-263-5731
Mailing Address - Fax:208-265-4716
Practice Address - Street 1:9399 RIDGETOP BLVD NW STE 101
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8580
Practice Address - Country:US
Practice Address - Phone:360-516-1210
Practice Address - Fax:833-287-7170
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010008010OtherREGENCE BLUE SHIELD
ID001245200Medicaid
ID002418800Medicaid
IDT0049OtherBLUE CROSS PROVIDER