Healthcare Provider Details

I. General information

NPI: 1679676233
Provider Name (Legal Business Name): STEVEN THOMAS SORENSEN DO, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC10 5600 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131
US

IV. Provider business mailing address

MSC10 5600 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2231
  • Fax: 505-272-8098
Mailing address:
  • Phone: 505-272-2231
  • Fax: 505-272-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2024-0192
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: