Provider Demographics
NPI:1528333721
Name:SORG, PAULA JANE (LMT # 3321)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JANE
Last Name:SORG
Suffix:
Gender:F
Credentials:LMT # 3321
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 BRIDGE CREST DR
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-4500
Mailing Address - Country:US
Mailing Address - Phone:256-520-0663
Mailing Address - Fax:
Practice Address - Street 1:15093 E LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-7219
Practice Address - Country:US
Practice Address - Phone:256-520-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3321OtherALABAMA LICENSE NUMBER