Provider Demographics
NPI:1376177519
Name:PHOENIX PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:PHOENIX PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-205-0797
Mailing Address - Street 1:10121 W CLEARWATER AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3500
Mailing Address - Country:US
Mailing Address - Phone:509-205-0797
Mailing Address - Fax:
Practice Address - Street 1:10121 W CLEARWATER AVE STE 113
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3500
Practice Address - Country:US
Practice Address - Phone:509-205-0797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy