Healthcare Provider Details

I. General information

NPI: 1508114364
Provider Name (Legal Business Name): COURTNEY ELIZABETH SORAN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. COURTNEY ELIZABETH ATWELL

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 HIGHLANDS PARKWAY NORTH
TACOMA WA
98406
US

IV. Provider business mailing address

4560 SE INTERNATIONAL WAY STE. 100
MILWAUKIE OR
97222
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-7112
  • Fax: 253-752-7265
Mailing address:
  • Phone: 971-206-5200
  • Fax: 971-206-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160291266
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: