Healthcare Provider Details

I. General information

NPI: 1245378504
Provider Name (Legal Business Name): JILINDA KAY MORTENSEN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N MONITOR ST
WEST POINT NE
68788-1555
US

IV. Provider business mailing address

709 LOGAN ST
SCRIBNER NE
68057-3114
US

V. Phone/Fax

Practice location:
  • Phone: 402-372-2372
  • Fax:
Mailing address:
  • Phone: 402-372-7964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number511
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: