MEDICARE: DANIEL RAY SORENSEN PT, MSPT

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	6318	AZ
2	225100000X	Physical Therapist	PT5277	AR

General Provider Information

NPI Number	:	1770708455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL RAY SORENSEN PT, MSPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 W PLEASANT GROVE RD STE 104
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8514
Country	:	US
Telephone Number	:	479-636-1187
Fax Number	:	479-636-1197

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	05/05/2023

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