Provider Demographics
NPI:1194854919
Name:SORENSEN, MARCIA K (PT)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:K
Last Name:SORENSEN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7526 FINNIE RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:IL
Mailing Address - Zip Code:60541-9451
Mailing Address - Country:US
Mailing Address - Phone:308-788-1146
Mailing Address - Fax:630-230-3105
Practice Address - Street 1:7526 FINNIE RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:IL
Practice Address - Zip Code:60541-9451
Practice Address - Country:US
Practice Address - Phone:630-878-8114
Practice Address - Fax:630-230-3105
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932114OtherBLUE CROSS BLUE SHIELD