Provider Demographics
NPI:1073083481
Name:SORENSEN, ANDREW LEE (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-625-0662
Mailing Address - Fax:
Practice Address - Street 1:136 W BELMONT DR STE 12
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3064
Practice Address - Country:US
Practice Address - Phone:706-625-0662
Practice Address - Fax:706-625-0582
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016048225100000X
GAPT015839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist