Individual
JARED MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC
Contact information
Practice address
1157 N 300 W, PROVO, UT 84604-6124
(801) 357-1250
Mailing address
1157 N 300 W, PROVO, UT 84604-6124
(801) 357-1250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1968
WY
Other
Enumeration date
07/14/2020
Last updated
02/13/2023
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