Provider Demographics
NPI:1912472838
Name:SODERBERG, ARIEL KAYE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ARIEL
Middle Name:KAYE
Last Name:SODERBERG
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 1:5956B KAMIAKIN TRL
Mailing Address - Street 2:
Mailing Address - City:FAIRCHILD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:99011-2210
Mailing Address - Country:US
Mailing Address - Phone:660-221-3377
Mailing Address - Fax:
Practice Address - Street 1:5956B KAMIAKIN TRL
Practice Address - Street 2:
Practice Address - City:FAIRCHILD AFB
Practice Address - State:WA
Practice Address - Zip Code:99011-2210
Practice Address - Country:US
Practice Address - Phone:660-221-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-07
Last Update Date:2018-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60899541225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist