Provider Demographics
NPI:1457014839
Name:SORENSEN, KORTNEY (ATC)
Entity Type:Individual
Prefix:
First Name:KORTNEY
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8083 CO-165
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:CO
Mailing Address - Zip Code:81069
Mailing Address - Country:US
Mailing Address - Phone:719-489-2271
Mailing Address - Fax:
Practice Address - Street 1:CO-165
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:CO
Practice Address - Zip Code:81069
Practice Address - Country:US
Practice Address - Phone:719-489-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2000018984207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine