Provider Demographics
NPI:1679634661
Name:SORVIG, AARON ROSS (PT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:ROSS
Last Name:SORVIG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 9TH ST E STE 401
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3381
Mailing Address - Country:US
Mailing Address - Phone:701-364-2739
Mailing Address - Fax:
Practice Address - Street 1:1420 9TH ST E STE 401
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3381
Practice Address - Country:US
Practice Address - Phone:701-364-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7628225100000X
ND2004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400242693OtherMEDICARE MN
NDP01525459OtherND MEDICARE
MN650002649Medicare PIN
MNHP53973OtherHEALTHPARTNERS
MN650002648Medicare PIN
MN6406033OtherSELECT CARE
MN470149600Medicaid
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN