Healthcare Provider Details

I. General information

NPI: 1568401982
Provider Name (Legal Business Name): PLATTE RIVER REHAB MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E 3RD ST
NORTH PLATTE NE
69101-4032
US

IV. Provider business mailing address

321 E 3RD ST
NORTH PLATTE NE
69101-4032
US

V. Phone/Fax

Practice location:
  • Phone: 308-534-9100
  • Fax: 308-534-9112
Mailing address:
  • Phone: 308-534-9100
  • Fax: 308-534-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number23650
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLINE ERICA SORENSON
Title or Position: OWNER
Credential: M.D.
Phone: 308-534-9100