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Individual
HEATHER MORTENSON
Active
Individual
HEATHER MORTENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10295-24
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000083455
MEDICARE
WI
05
—
36146500
—
WI
Enumeration date
07/15/2008
Last updated
06/29/2011
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