MEDICARE: SOPHIA CORBETT-KROETCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	60443545	WA

General Provider Information

NPI Number	:	1447675228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA CORBETT-KROETCH

Provider Business Mailing Address
First Line	:	4641 56TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-3933
Country	:	US
Telephone Number	:	206-755-9162
Fax Number	:

Provider Business Practice Location Address
First Line	:	3320 W MCGRAW ST
Second Line	:	#4
City	:	SEATTLE
State	:	WA
Zip	:	98199-3241
Country	:	US
Telephone Number	:	206-283-9910
Fax Number	:	206-283-9935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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Directions to “ SOPHIA CORBETT-KROETCH ” Practice Location

Language	Start Address	Practice Location

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