Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 130254 | MI |
NPI | 1043630494 |
---|---|
Provider Name | Mr. Drew Sorensen |
First Address | Knoxville, TN 37930-2709 |
Second Address | Knoxville, TN 37923-4703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 05/05/2014 |