MEDICARE: MARIA SORENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	111152	IA

General Provider Information

NPI Number	:	1487308938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA SORENSON

Provider Business Mailing Address
First Line	:	401 5TH AVE
Second Line	:
City	:	SLATER
State	:	IA
Zip	:	50244-7744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 5TH AVE
Second Line	:
City	:	SLATER
State	:	IA
Zip	:	50244-7744
Country	:	US
Telephone Number	:	515-509-1819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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Directions to “ MARIA SORENSON ” Practice Location

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