Provider Demographics
NPI:1902947195
Name:GRIEVE, SOREN LONG (PT)
Entity Type:Individual
Prefix:MS
First Name:SOREN
Middle Name:LONG
Last Name:GRIEVE
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 1:3333 CONCORDIA DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2603
Mailing Address - Country:US
Mailing Address - Phone:712-252-5123
Mailing Address - Fax:
Practice Address - Street 1:3439 GLEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1761
Practice Address - Country:US
Practice Address - Phone:712-277-8295
Practice Address - Fax:712-277-8206
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23860OtherWELLMARK BCBS OF IA
NE100251289-00Medicaid
IA0445361Medicaid
SD5835230Medicaid
IA0445361Medicaid