Provider Demographics
NPI:1063952687
Name:SORRELL, THOMAS (PT , DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SORRELL
Suffix:
Gender:M
Credentials:PT , DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W DUNLAP AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 W DUNLAP AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2817
Practice Address - Country:US
Practice Address - Phone:602-870-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist