Individual
MRS. LISA MORTENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS ATC
Contact information
Practice address
405 S 100 E STE 102, PLEASANT GROVE, UT 84062-2751
(801) 785-9991
(801) 785-9417
Mailing address
1915 W 140 S, OREM, UT 84058-2062
(801) 812-2736
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
6332468-4810
UT
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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