Healthcare Provider Details

I. General information

NPI: 1043630494
Provider Name (Legal Business Name): DREW SORENSEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8904 CROSS PARK DR
KNOXVILLE TN
37923-4703
US

IV. Provider business mailing address

PO BOX 32709
KNOXVILLE TN
37930-2709
US

V. Phone/Fax

Practice location:
  • Phone: 865-558-6484
  • Fax: 865-584-4037
Mailing address:
  • Phone: 865-558-6484
  • Fax: 865-584-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number130254
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: