Provider Demographics
NPI:1346338100
Name:SORENSON, BECKY J (DPT)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:J
Last Name:SORENSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:J
Other - Last Name:FUHRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-253-5300
Mailing Address - Fax:
Practice Address - Street 1:2430 20TH ST SW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-6201
Practice Address - Country:US
Practice Address - Phone:701-253-5300
Practice Address - Fax:701-253-5402
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1308225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54637Medicaid
ND23689Medicare PIN