Provider Demographics
NPI:1881171643
Name:SORDAHL, KATHRYN (LMT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:SORDAHL
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 1:2904 165TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6023
Mailing Address - Country:US
Mailing Address - Phone:425-442-7477
Mailing Address - Fax:
Practice Address - Street 1:16212 BOTHELL EVERETT HWY STE E
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1235
Practice Address - Country:US
Practice Address - Phone:425-745-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00018144225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist