Provider Demographics
NPI:1407847742
Name:BARDIN-SORENSEN, BETTINA M (MSPT)
Entity Type:Individual
Prefix:MS
First Name:BETTINA
Middle Name:M
Last Name:BARDIN-SORENSEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9543
Mailing Address - Country:US
Mailing Address - Phone:541-386-1211
Mailing Address - Fax:541-386-7211
Practice Address - Street 1:2002 12TH ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9543
Practice Address - Country:US
Practice Address - Phone:541-386-1211
Practice Address - Fax:541-386-7211
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR205208Medicaid
107486Medicare ID - Type Unspecified