Provider Demographics
NPI:1144936956
Name:SOREM, JULIE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:SOREM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COTTON CIR
Mailing Address - Street 2:
Mailing Address - City:JOSEPHINE
Mailing Address - State:TX
Mailing Address - Zip Code:75173-8475
Mailing Address - Country:US
Mailing Address - Phone:469-742-1426
Mailing Address - Fax:
Practice Address - Street 1:100 COTTON CIR
Practice Address - Street 2:
Practice Address - City:JOSEPHINE
Practice Address - State:TX
Practice Address - Zip Code:75173-8475
Practice Address - Country:US
Practice Address - Phone:469-742-1426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT124137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist