MEDICARE: RENEE SORENSEN OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	101772	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HP45887	OTHER	MN	HEALTH PARTNERS
2	6406624	OTHER	MN	MEDICA
3	695S2SO	OTHER	MN	BCBS MN

General Provider Information

NPI Number	:	1477634038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE SORENSEN OTR

Provider Business Mailing Address
First Line	:	100 13TH AVE N
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-1067
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 1ST ST N
Second Line	:
City	:	COLD SPRING
State	:	MN
Zip	:	56320-1401
Country	:	US
Telephone Number	:	763-689-5385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/09/2007

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Directions to “ RENEE SORENSEN OTR” Practice Location

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