Provider Demographics
NPI:1437253457
Name:SERWOLD, SONJA J (PT)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:J
Last Name:SERWOLD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-4570
Mailing Address - Country:US
Mailing Address - Phone:360-799-6921
Mailing Address - Fax:360-799-6922
Practice Address - Street 1:100 2ND AVE S
Practice Address - Street 2:STE 160
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3551
Practice Address - Country:US
Practice Address - Phone:206-601-6084
Practice Address - Fax:425-385-0988
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist