Provider Demographics
NPI:1457098238
Name:SORENSEN, KEELEY (LMT)
Entity Type:Individual
Prefix:
First Name:KEELEY
Middle Name:
Last Name:SORENSEN
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 1:1221 A ST NE APT B306
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4167
Mailing Address - Country:US
Mailing Address - Phone:253-880-7496
Mailing Address - Fax:
Practice Address - Street 1:11014 SE 192ND ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-7432
Practice Address - Country:US
Practice Address - Phone:253-852-8640
Practice Address - Fax:253-854-2690
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60986684225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist