Provider Demographics
NPI:1295015642
Name:SORVIG, KRISTIN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SORVIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 MAIN ST N
Mailing Address - Street 2:UNIT B
Mailing Address - City:HORACE
Mailing Address - State:ND
Mailing Address - Zip Code:58047-4640
Mailing Address - Country:US
Mailing Address - Phone:701-361-4984
Mailing Address - Fax:
Practice Address - Street 1:534 MAIN ST N
Practice Address - Street 2:UNIT B
Practice Address - City:HORACE
Practice Address - State:ND
Practice Address - Zip Code:58047-4640
Practice Address - Country:US
Practice Address - Phone:701-361-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8840225100000X
ND1676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0064-0013977OtherMEDICA
MN225100000XMedicaid
MN1295015642OtherBLUE CROSS BLUE SHIELD OF MN
MNP01023766Medicare PIN
MN1295015642OtherBLUE CROSS BLUE SHIELD OF MN
MN0064-0013977OtherMEDICA