Provider Demographics
NPI:1487905196
Name:SOLE SISTERS PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SOLE SISTERS PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MECHELE
Authorized Official - Last Name:SCHRAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-687-7147
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-0972
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2312 W MAIN ST
Practice Address - Street 2:#117
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4234
Practice Address - Country:US
Practice Address - Phone:360-687-7147
Practice Address - Fax:360-687-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-232-171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty