Provider Demographics
NPI:1679813646
Name:SOJOURNER, ASTORIA (LMT)
Entity type:Individual
Prefix:MS
First Name:ASTORIA
Middle Name:
Last Name:SOJOURNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:ASTORIA
Other - Middle Name:
Other - Last Name:SOJOURNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:200 GEMINI LANE
Mailing Address - Street 2:
Mailing Address - City:CAVE JUNCTION
Mailing Address - State:OR
Mailing Address - Zip Code:97523
Mailing Address - Country:US
Mailing Address - Phone:541-450-8958
Mailing Address - Fax:
Practice Address - Street 1:825 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1634
Practice Address - Country:US
Practice Address - Phone:541-955-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist