Provider Demographics
NPI:1326016189
Name:MOORMEIER, SOPHIA YOLANDA (LMP)
Entity type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:YOLANDA
Last Name:MOORMEIER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:YOLANDA
Other - Last Name:ELKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:3360 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-423-6110
Mailing Address - Fax:360-423-8078
Practice Address - Street 1:1004 FIR ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-423-6110
Practice Address - Fax:360-423-8078
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020619225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist