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General NPI Number Information
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NPI Number | 1336506112
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Entity Type | Individual
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Provider Name | JORDAN MORTENSEN
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Gender | Female
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 1325 TIMBER DR E
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City | GARNER
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State | NC
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Zip | 27529-6924
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Country | US
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Telephone | 919-863-6991
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 S WATER ST
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City | PITTSBURGH
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State | PA
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Zip | 15203-2307
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT023695
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P17187
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License Number State | NC
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