Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT30641 | FL |
N | 2251S0007X | Physical Therapist - Sports | PT30641 | FL |
NPI | 1053785204 |
---|---|
Provider Name | Mrs. Kristin Lorrie Mortenson |
First Address | Cape Coral, FL 33990-3819 |
Second Address | Cape Coral, FL 33990-3819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2015 |
Last Update Date | 25/11/2015 |