Provider Demographics
NPI:1346771300
Name:SORGEN GREENBERG, BROOK RENE (LMP)
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:RENE
Last Name:SORGEN GREENBERG
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:BROOK
Other - Middle Name:RENE
Other - Last Name:SORGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:16123 N MEADOWDALE RD
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-4547
Mailing Address - Country:US
Mailing Address - Phone:206-354-0641
Mailing Address - Fax:
Practice Address - Street 1:2918 NE 55TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5532
Practice Address - Country:US
Practice Address - Phone:206-354-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023006225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist