Basic Information
| Provider Information | |||||||||
| NPI: | 1265408405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SORENSEN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14287 N 87TH ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852603698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807220853 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16611 S 40TH ST | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850480562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807061199 | ||||||||
| FaxNumber: | 4807063999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 03/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5560 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.