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Individual

BARTLEY BRETT MORTENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
1055 N 500 W, SUITE 122, PROVO, UT 84604-3305
(801) 429-0610
(801) 429-0629
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 429-8000
(801) 429-8150

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
51321992401
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
219420
ALTIUS
UT
01
64-00662
UNITED HEALTHCARE
UT
01
76205
PEHP
UT
01
827322
DMBA
UT
05
870281028000
UT
01
P00146137
PALMETTO
UT
Enumeration date
09/02/2006
Last updated
01/11/2010
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