Healthcare Provider Details

I. General information

NPI: 1356718290
Provider Name (Legal Business Name): AMIE SORENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIE CRESTO

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 N 11TH AVE
HANFORD CA
93230-4511
US

IV. Provider business mailing address

5533 W HILLSDALE AVE STE A
VISALIA CA
93291-5367
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-1027
  • Fax: 559-582-8105
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number42876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: