Provider Demographics
NPI:1649494964
Name:SORSETH, RENEE YVONNE (LMT)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:YVONNE
Last Name:SORSETH
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 1:3312 ONYX PL
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4336
Mailing Address - Country:US
Mailing Address - Phone:541-485-8580
Mailing Address - Fax:
Practice Address - Street 1:3469 HILYARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3815
Practice Address - Country:US
Practice Address - Phone:541-485-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#5689225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist