Active NPI
Marissa R Mortensen, DPT
- Physical Therapist
- Hoffman Estates, IL
National Provider Identifier
1396092722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070-019194
- Practice address
- 5050 Sedge Blvd
Hoffman Estates, IL 60192-3712 - Phone
- (847) 854-8219
- Fax
- (847) 854-8278
- NPI assigned
- Aug 3, 2012
- Last updated
- Aug 3, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-019194 | IL | Primary |
Addresses
Primary practice location
5050 Sedge Blvd
Hoffman Estates, IL 60192-3712
Mailing address
5050 Sedge Blvd
Hoffman Estates, IL 60192-3712
Phone (847) 854-8219
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 |
|---|---|---|---|
| 070-019194 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343952000000",
"number": "1396092722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5050 SEDGE BLVD",
"city": "HOFFMAN ESTATES",
"state": "IL",
"postal_code": "601923712",
"telephone_number": "847-854-8219",
"fax_number": "847-854-8278"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5050 SEDGE BLVD",
"city": "HOFFMAN ESTATES",
"state": "IL",
"postal_code": "601923712",
"telephone_number": "847-854-8219",
"fax_number": "847-854-8278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORTENSEN",
"first_name": "MARISSA",
"middle_name": "R",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-03",
"last_updated": "2012-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070-019194",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hoffman Estates, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.