Healthcare Provider Details

I. General information

NPI: 1275728040
Provider Name (Legal Business Name): PAULA SORENSEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 2ND ST
NEENAH WI
54956-2883
US

IV. Provider business mailing address

976 EVERGREEN LN
NEENAH WI
54956-4968
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-2155
  • Fax: 920-720-7350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number3993-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: