Healthcare Provider Details

I. General information

NPI: 1730826595
Provider Name (Legal Business Name): LAUREN B SORENSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S LOCUST ST STE B1
GRAND ISLAND NE
68801-8200
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-210-8753
  • Fax: 308-210-8754
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3365
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: