Active NPI
Jordan Mortensen
- Physical Therapist
- Garner, NC
National Provider Identifier
1336506112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P17187
- Practice address
- 1325 Timber Dr E
Garner, NC 27529-6924 - Phone
- (919) 863-6991
- NPI assigned
- Jan 25, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT023695 | PA | |
| Physical Therapist | 225100000X | P17187 | NC | Primary |
Addresses
Primary practice location
1325 Timber Dr E
Garner, NC 27529-6924
Mailing address
3200 S Water St
Pittsburgh, PA 15203-2307
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P17187 | NC | MD | Physical Therapist |
| PT023695 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563235200000",
"number": "1336506112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3200 S WATER ST",
"city": "PITTSBURGH",
"state": "PA",
"postal_code": "152032307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 TIMBER DR E",
"city": "GARNER",
"state": "NC",
"postal_code": "275296924",
"telephone_number": "919-863-6991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTENSEN",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-25",
"last_updated": "2019-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT023695",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P17187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garner, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.