1598920217 NPI number — ABIGAIL SORENSEN-BRITTICH DPT

Table of content: ABIGAIL SORENSEN-BRITTICH DPT (NPI 1598920217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598920217 NPI number — ABIGAIL SORENSEN-BRITTICH DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORENSEN-BRITTICH
Provider First Name:
ABIGAIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SORENSEN
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598920217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2547 PLAINFIELD NAPERVILLE RD
Provider Second Line Business Mailing Address:
SUITE 152
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60564-8909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-974-4378
Provider Business Mailing Address Fax Number:
630-515-1536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10105 74TH ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
KENOSHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53142-7519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-974-4348
Provider Business Practice Location Address Fax Number:
630-515-1536
Provider Enumeration Date:
07/22/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  070016484 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 11832-024 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)