Provider Demographics
NPI:1659965119
Name:SORRELL, CARRIE F (LMT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:F
Last Name:SORRELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-7020
Mailing Address - Country:US
Mailing Address - Phone:406-883-4216
Mailing Address - Fax:406-883-6761
Practice Address - Street 1:801 4TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-7020
Practice Address - Country:US
Practice Address - Phone:406-883-4216
Practice Address - Fax:406-883-6761
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2683225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty