Provider Demographics
NPI:1316653033
Name:STEGLICH, SORAYA FATIMA (LMT)
Entity type:Individual
Prefix:
First Name:SORAYA
Middle Name:FATIMA
Last Name:STEGLICH
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 1:400 E EVERGREEN BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3264
Mailing Address - Country:US
Mailing Address - Phone:360-721-5301
Mailing Address - Fax:
Practice Address - Street 1:400 E EVERGREEN BLVD STE 215
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3264
Practice Address - Country:US
Practice Address - Phone:360-313-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61343014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist