Individual
MISS MELISSA ANN MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7536
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
293G4MO
BLUE CROSS BLUE SHEILD
MN
01
—
64-05523
MEDICA
MN
01
—
HP50266
HEALTH PARTNERS
MN
01
—
MR143-1025279
PREFERRED ONE
MN
Enumeration date
07/07/2005
Last updated
04/16/2010
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