Provider Demographics
NPI:1962689562
Name:SORENA, CHARISSE (PT)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:
Last Name:SORENA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14535 DRAFT HORSE LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-1031
Mailing Address - Country:US
Mailing Address - Phone:561-791-7037
Mailing Address - Fax:
Practice Address - Street 1:14535 DRAFT HORSE LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-1031
Practice Address - Country:US
Practice Address - Phone:561-791-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist