Provider Demographics
NPI:1194975631
Name:SORENSEN, JERRY DEAN (PT)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:DEAN
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 KIKI DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7314
Mailing Address - Country:US
Mailing Address - Phone:406-459-2076
Mailing Address - Fax:
Practice Address - Street 1:3815 KIKI DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7314
Practice Address - Country:US
Practice Address - Phone:406-459-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2008-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPT344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist