Healthcare Provider Details

I. General information

NPI: 1609351667
Provider Name (Legal Business Name): MATTHEW SORENSEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SOLAR DR STE 204
OXNARD CA
93036-2602
US

IV. Provider business mailing address

2100 SOLAR DR STE 204
OXNARD CA
93036-2602
US

V. Phone/Fax

Practice location:
  • Phone: 970-275-1671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number295587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: