Healthcare Provider Details

I. General information

NPI: 1114586419
Provider Name (Legal Business Name): ERIC JOHN SORENSEN MSOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 02/09/2020
Certification Date: 02/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

4147 BENJAMIN DR UNIT 283
WOODBURY MN
55129-2253
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number105938
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number105938
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: